69 Orchard Street, Ramsey, NJ 07430 email@example.com
click here for our brochure fall 2017
Student Name: ________________________________________
Male / Female Age: ________ DOB: _____________________
Parent Name: _______________________________________
Parent Name: ________________________________________
City: _______________________State _____ Zip: ____________
Home Phone: _________________________________________
Cell Phone: ____________________________________________
E-Mail Address: _______________________________________
Emergency Contact Name: ____________________________
Level (circle one): TT RR Beg Int Adv Adv+
Session Length (circle one): 8weeks 16weeks 32weeks
May we use your child’s photo on our website or in advertisements? Yes No
How did you hear about us? (if referred by current student, please provide name)____________________________________________
Are there any medical conditions of which we should be aware? Circle one: Yes No
If yes, explain: ________________________________________
Flipper’s Gymnastics recommends that every student complete an annual physical examination.
Physician Name: ______________________________________
When was your child’s last physical exam? ___________
Eligibility to participate in class at Flipper’s Gymnastics requires a completed student registration form with release of liability and emergency medical authorization and full tuition on or before the first day of class.
LIABILITY RELEASE: Must be signed by parents or guardians before child can participate.
Parent/Guardian (please print name):
acknowledge that by participating in gym activities and/or by moving around in the gym, with its equipment, apparatus and possible uneven surfaces, there is risk of injury. I acknowledge that I accept the risk and waive the option to sue should I, or any minors for whom I am responsible, incur injury. By waiving the option to sue, I also thereby release Flipper’s Gymnastics, L.L.C. and its agents or employees from liability for such injury.
I have read this release and understand all of its terms. I understand that by signing this release, I am giving up substantial rights. I execute it voluntarily and with full knowledge of its significance.
Signature of Parent/Guardian: ________________________
Our classes will be priced as follows:
45 minutes (Tiny Tots & Rockin’ Rollers)
8 weeks – $160
16 weeks – $275
32 weeks – $500
60 minutes (Beginner classes)
8 weeks – $210
16 weeks – $365
32 weeks – $675
75 minutes (Intermediate classes)
8 weeks – $265
16 weeks – $450
32 weeks – $840
90 minutes (Advanced/Advanced Plus classes)
8 weeks – $315
16 weeks – $540
32 weeks – $980
Adult classes will run on a pay-as-you-go basis. The price will be $25/class. Multiple students in one family will earn a discount – full price for the first child, 10% off the second, and 12% off all additional children. A membership fee of $50/student will be charged once each year at the time of enrollment. This fee will offset insurance costs. The fee is not discounted for multiple students in a single family. Please return enrollment forms to 21 Heather Lane, Mahwah, NJ 07430.