69 Orchard Street, Ramsey, NJ 07430
(201) 327-FLIP
flippersgym@outlook.com

Registration Form

click here for our brochure fall 2017-spring 2018

Student Name: ________________________________________
Male / Female Age: ________ DOB: _____________________
Parent Name: _______________________________________
Parent Name: ________________________________________
Address: ______________________________________________
City: _______________________State _____ Zip: ____________
Home Phone: _________________________________________
Cell Phone: ____________________________________________
E-Mail Address: _______________________________________
Emergency Contact Name: ____________________________
Phone: ________________________________________________
Level (circle one): TT  RR  Beg  Int  Adv  Adv+
Day/Time: _____________________________________________
Session Length (circle one): 8weeks 16weeks 32weeks
Tuition: _______________________________________________
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: ______________________________________
Phone: ________________________________________________
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.

I, ______________________________________________________
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: ________________________
Date: __________________________________________________

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/Trampoline & Tumbling 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 or $225 for a 10-class card.
  
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 69 Orchard Street, Ramsey, NJ 07446.