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10.0 ACADEMY Swim Lesson Registration 181 Great Road, P.O. Box 454, Stow, MA 01775 Phone 978-897-8184 / Fax 978-897-8198 10-0gymnastics.org |
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Family's LAST NAME: HOME PHONE: |
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Mother's Name: Email Contact: |
| Father's Name: Email Contact: |
| Address: Town: Zip Code: |
| Work Phone: ( ) - ext.____ Cell Phone: ( ) - |
| Child's Name | DOB | Session | Time | Level | Tuition |
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Annual Registration Fee: $15/Family |
$15.00 |
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| Tuition is due with registration. |
Tuition Due: |
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list any special needs, allergies, medications, learning disabilities or any
other information we may need to make your child's experience a positive
one.
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| AUTHORIZATION
OF PARTICIPATION: I give all members of my family permission to
participate in any program(s), camps, swim, special events of 10.0 ACADEMY.
I hereby certify that to the best of my knowledge my children/family are in
sufficient physical condition to participate safely in all activities and I
am willing to provide a Physician's certificate if so desired by the
Director. I understand that it is the expressed intent of 10.0 ACADEMY to
provide for the safety and protection of my children/family and in
consideration for allowing my family to use these facilities. I hereby
forever release 10.0 ACADEMY, it's officers, employees, teachers, and
coaches from all liability for any and all damages and injuries suffered by
my children/family while under the instruction, supervision, or control of
10.0 ACADEMY. I recognize that participation of any sport, including
gymnastics which involves height, motion, and rotation, that injury can
occur. This includes severe injuries including permanent paralysis or even
death. I authorize 10.0 ACADEMY to seek medical treatment at the nearest
Medical Facility in case of emergency. ENROLLMENT AGREEMENT AND REFUND POLICIES: This will secure a place for your child(ren) in a limited class/camp/swim program. Payments are accepted by Cash, Check, MasterCard, Visa, or Discover. No refunds or credits will be given to any students after the summer program has started or for missed classes, withdrawal, early dismissal, or for illness. All summer programs are non-transferable to other persons or succeeding sessions. A surcharge of $25 will be charged for any returned check. 10.0 ACADEMY reserves the right to cancel any classes due to weather or lack of enrollment. There are NO make-ups permitted during the summer program (Swim Class may be rescheduled or delayed due to severe weather). This acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. I hereby execute and deliver this waiver and release form to permit my child's/children's participation in the program(s). I have read and agree to the enrollment conditions as stated above. Parent's Signature:____________________________________________________________ Date:_____________________
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Total Tuition Due:__________________ Enclosed Payment:__________________ Check #:________________ CCard # (mc/visa/dis)______________________________________________________________ Exp Date______/______ ZipCode:__________ Signature:_______________________________________________________________________ Date:_________________
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