POWER PLUS GYM

REGISTRATION & RELEASE

CHILD #1_____________________________________AGE:_____DOB:___________

CHILD #2_____________________________________AGE:_____DOB:___________

CHILD #3_____________________________________AGE:_____DOB:___________

PARENT/LEGAL GUARDIAN:_________________________PHONE #____________

ADDRESS:__________________________________CITY:_______________________

E-MAIL ADDRESS:______________________________________________________

EMERGENCY CONTACT:____________________________PHONE #____________

CIRCLE ALL CLASSES: TUMBLING/TRAMPOLINE/DOUBLE-MINI

2 TUMBLING CLASSES PER WEEK 3 TUMBLING CLASSES PER WEEK

TINY TOTS TUMBLING COMPETITIVE TEAM CHEERLEADING DANCE

COMBO #1 (3-5 YRS.) COMBO #2 (6-8 YRS.)

*COMBO CLASSES INCLUDE TUMBLING AND DANCE OR CHEER

LEVEL: SUB-BEGINNER BEGINNER ADVANCED-BEGINNER SUB-NOVICE

NOVICE INTERMEDIATE SUB-ADVANCED ADVANCED ELITE

I PREFER: MON TUES WED THURS FRI SAT ANY DAY

I PREFER: MORNINGS AFTERNOONS EVENINGS ANY TIME

WAIVER

I, the parent and/or legal guardian of the above-named child/children, for myself, my heirs, executors and administrators,
do hereby waive, release and discharge any and all claims for any and all damages or accidents which may occur while my

child is a participant or student of Power Plus and/or their agents, representatives or successors now and forever.

I, do hereby understand the contents of the foregoing instrument and hereby agree and confirm.

________________________________________________ __________________

(Parent/Legal Guardian) (Date)

REGISTRATION FEE PAID: YES NO CHECK #_____ CASH

($20 FOR FIRST CHILD, $15 FOR SECOND CHILD, $10 FOR THIRD CHILD)

Valid September 1^st – August 31^st of the following year