Cary Gymnastics & Dance Center

Phone 847/516-1064      Fax 847/516-0274

Registration Form

Last Name______________________________            Parent's Name____________________________

Address_________________________________________City____________________Zip_______________

Home Phone__________________________    Cell Phone_________________________

E-Mail _____________________________________________________

Child's Name____________________

B-Day__________

Class_______________________

Day______________    Time_________  Price_________

2nd Child's Name _________________

B-Day___________

Class________________________

Day______________    Time_________  Price_________

3rd Child's Name__________________

B-Day___________

Day______________    Time_________  Price_________

Class________________________

No Classes Septmeber 6. Take $10.00 off  MONDAY classes.

Please note: No refunds after the first week of classes. No refunds for camps or clinics.

Sub Total___________________

New Member Registration Fee $25.00 per child____________________ $50.00 max per family

Total Payment Due___________________

Mail, Fax, or drop off your registration and payment as soon as possible to ensure your child's spot in class. We will only contact you if your child did not get into his/her class. Make checks payable to Cary Gymnastics Center. __  Check               ___ Visa         ___ Mastercard Credit Card #_______________________________________________    Exp. Date___________

Participant specifically assumes all risks of injury arising out of his or her presence on or about the premises, or his/her use or intended use of equipment or facilities, or his/her participation in the activities of Cary Gymnastics Center, on or about the premises or at another location and does hereby for himself or herself, his or her heirs, excutors and administrators waive, release and agree to hold free all claims for damages, the Cary Gymnastics Center, and all its respective officers and employees.

Parent or Guardian's Signature_________________________________________ Date___________

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