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Participant Release Form

To print click here ->   Participant Release Form  

Call before you fill out the form for a validation code.

GREAT FALLS GYMNASTICS ACADEMY, INC. (GFGA) PARTICIPANT RELEASE FORM

Child:

First Last  Male/Female  Birthday Month: :   Year:

Class Day Class Time Class Name
_______________________________________________________________________________________________________________________________________________

2nd Child:

First Last    Male/Female  Birthday Month: :   Year:

Class Day Class Time Class Name
_____________________________________________________________________________________________________________________________________________

Mother:

First Last Father: First Last

Address

City StateZip

Telephone

Cell Phone
E-mail
Client ID (If applicable)

GREAT FALLS GYMNASTICS ACADEMY, INC. (GFGA) PARTICIPANT RELEASE FORM
 
HEALTH STATEMENT: I/we the undersigned understand that physical activity is a regular part of GFGA programs. By signing this form,
I acknowledge that I and my child are in excellent physical shape and need no restrictions from activity (unless noted below).
 
ANY MEDICAL/BEHAVIORAL/DEVELOPMENTAL CONDITIONS THAT WE SHOULD KNOW ABOUT?
__________________________________________________________________________________________________________
PAYMENTS
ü Our billing cycle and sessions are 4 weeks in length. Payment is due, in full, on your child’s first class of the session. A $10 late fee is assessed on
 the 10th day of each session on all outstanding balances. This fee continues to be added each month an outstanding balance remains.
 
ü If tuition is overdue by more than 2 billing cycles/sessions, your child's enrollment will be terminated. You will continue to be responsible for any
 outstanding balance on your account. In the event that your account is turned over for collections, a $25.00 fee will be added to your account.
 
ü Bounced checks are rare. However, if you do write a check which is rejected by your bank, you will be responsible for any incurred charges and
 an additional $30.00 nonsufficient funds fee.
 
ü An annual $25.00 non-refundable registration fee is due at the time of enrollment.
 
DROP POLICY
A TWO WEEK WRITTEN NOTICE PROVIDED TO OUR FRONT DESK IS REQUIRED WHEN DROPPING FROM A CLASS.
A verbal notice to the instructor or a message on the answering machine is not considered written notification.
Refunds are not given for missed classes and make-up classes are not guaranteed.
 
Clients are responsible for all accrued class fees while enrolled, regardless of attendance.
 
RISK OF LIABILITY
We, the staff of Great Falls Gymnastics Academy, Inc. (GFGA), recognize our obligation to make our students and their parents aware of the risks and hazards
associated with the sport of gymnastics, swimming, cheerleading, day camps, Mom & Tot classes or other activities held at GFGA facilities. Students and participating
parents may suffer injuries, possibly minor, serious or catastrophic in nature. Gymnastics, swimming, cheerleading, day camps, Mom & Tot Classes, and other activities
can be dangerous and can lead to injury and possibly death. Parents/guardians and their wards should be aware of the possibility of injury and follow all safety rules
and the coaches’ instructions. GFGA, its coaches, and other staff members will not accept responsibility for injury sustained by any student during the course of
gymnastics, swimming, cheerleading, day camps, and/or other activities. With the above in mind, and being fully aware of the risks and possibility of injury involved,
I consent to participate with my child/children in the programs offered by GFGA. I, my executors, and/or their representatives waive and release all rights and claims
for damages that I or my child may have against GFGA and/or its representatives, whether paid or volunteer.
PERMISSION TO TREAT
I hereby give permission for GFGA to contact trained professionals to administer emergency medical treatment to my child or myself should illness or injury occur.
I fully understand that GFGA staff/volunteers are not physicians or medical practitioners. With this in mind, I hereby release GFGA to render temporary First Aid
to my child or myself in the event of any illness or injury. Additionally, if deemed necessary, I give permission for GFGA to seek medical help, including transportation
by GFGA staff, whether paid or volunteer, to any healthcare facility, or the calling of an ambulance. I agree that I am responsible for all costs resulting from the rendering
of medical aid and ambulance services for the listed participants.
 

 I grant permission to use photographs, videotapes, recordings or any other record of GFGA programs containing my or my child’s image by/for GFGA. 

 Y / N  - Y for yes or N for no / must be completed

MEDICAL INSURANCE: I agree to carry Medical Insurance coverage for named participants during the duration of participation.
 
INSURANCE COMPANY  POLICY NUMBER
 
VERIFICATION & RELEASE: As a legal parent, guardian, or responsible party of those named on this waiver, I hereby verify by my
signature below that I accept the conditions of this release waiver.
X Date: 01/24/2012
Parent/Legal Guardian’s Signature required for participation                       
Validation code is required for electronic registration please call or e-mail for your code.
Code
406-727-8782   Call for your validation code / Required for participation

Comments

 

Remember your water bottle when you come to the gym!

815 1st Ave North

Great Falls, Montana

  59401

406-727-8782

Problems or questions regarding this website? officemanager@greatfallsgymnastics.com
Last updated: January 24, 2012.