Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING ...
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM NAME
AGE
BIRTHDATE
DAY AND TIME OF CLASS
(Please note male or Female) 1. 2. 3. 4.
Mother’s name: Father’s name: Mother’s cell phone: Father’s cell phone: Address: City:
State & Zip: ___________________
Email Address: Emergency Contact: ______________________ Phone number: _______________________ How did you hear about Sienna Spirit? ___________________________________ Registration Fee $___35_________ Monthly Tuition $________________ *Registration fee is non-refundable and must be paid at time of enrollment. Tuition is due at the beginning of the month and considered late after the 15th. There is a $10.00 late fee per child if paid after the 15th.
1
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM SIENNA SPIRIT RELEASE, WAIVER OF LIABILITY, AND INDEMNIFICATION AGREEMENT In consideration for Sienna Spirit allowing my and/or my minor’s use of the SPRAI, its exercise programs, activities, and other services (collectively Facility), I, the undersigned, fully understand and agree to assume the sole risk of such use. Accordingly, I, on behalf of myself, spouse, heirs, estate, and assigns, expressly agree to release and hold harmless Sienna Spirit, and any of its present, former, or future subsidiaries, divisions, and affiliates, and its and their respective directors, officers, employees, contractors, agents, heirs, legal successors and assigns (collectively Released Parties) from and against any and all claims, suits, demands, losses, damages, expenses, or liability arising under any cause, or claimed under any theory of law, that may arise from any property damage or loss, injury, illness, or death, including that which may result to me and/or my minor, during or arising in any way from my and/or my minor’s use of the Facility, including but not limited to, any such claims arising from the negligence (whether active or passive, sole or concurrent) of any of the Released Parties. I understand and agree that it is my responsibility to assess the hazards presented by use of the Facility, and further agree that I am the ultimate judge as to whether I and/or my minor can use the Facility without risk or injury to ourselves. If a medical clearance must be obtained prior to my and/or my minor’s use of the Facility, I agree to consult a physician and obtain written permission prior to use of the Facility. I agree that I am responsible for monitoring my and my minor’s condition during use of the Facility, and if any symptoms occur, my minor or I will cease such use and seek assistance immediately. I understand that use of the Facility is voluntary and is not a requirement of Sienna Spirit. By signing this Release and Waiver of Liability, I affirm that I have read this form in its entirety, that I understand its content, and that I am signing it voluntarily. I also affirm that my questions regarding the Facility have been answered to my satisfaction.
____________________________________________________ Printed Full Name of Participant over age 18 (First, Middle, Last)
____________________________________________________ Signature of Participant over age 18 Date _______________ Indemnification for Minor Participants: The undersigned parent or guardian further agrees to indemnify, save and hold harmless the Released Parties from and against any and all claims, suits, demands, losses, damages, expenses, or liability arising under any cause, or claimed under any theory of law, that may arise from any property damage or loss, injury, illness, or death, that may brought, alleged, or incurred by or on behalf of the minor and during or arising in any way from the minor’s use of the Facility, including but not limited to, any such claims arising from the negligence(whether active or passive, sole or concurrent) of any of the Released Parties.
__________________________________________________________ Printed Full Name of Minor Participant (First, Middle, Last)
__________________________________________________________ Signature of Parent or Guardian (required if Participant is under age 18) _______________________________ Date
2
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM
SIENNA SPIRIT, INC. MINOR CONSENT AND ASSUMPTION OF RISK STATEMENT In consideration of membership in the Sienna Spirit Inc., the parent (s) and /or legal guardian (s) of the minor Participant named below agreed. 1. The parent(s) and/or legal guardian(s) to and will instruct the minor participating in any Sienna Spirit and/or members activity or event and regularly thereafter, that he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the instructor of such condition and refuse to participate. 2. I/We fully understand and will instruct the minor participant that: A. There are risks and dangers associated with participation in gymnastic and cheerleading events and activities including but not limited to those of bodily injury, partial and/or total disability, paralysis and death. B. The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe. C. These risks and dangers may be causes by the negligence of the participant or the negligence of others. D. There may be other risks not known to us or are not reasonably foreseeable at the time. 3. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis/or death, however caused or alleged to be caused in whole or in by the negligence of the Sienna Spirit, its members, officials, sponsors, advertisers, directors, agents and employees. 4. I/We agree that this Consent and Assumption of Risk Statement covers each and every event or activity sponsored by the Sienna Spirit, Inc.
I/We Have Read the Above Waiver and Sign It Voluntarily. ________________________________________
_
Signature/Relationship
Date
________________________________________ Parent or Guardian Signature/Relationship
Date
Printed Name of Participant: _________________________________________ Address of Participant: ______________________________________________ Printed Name of Parent or Guardian: _________________________________ Member Institution: Sienna Spirit LLC 9600 Scanlan Trace E. Missouri City, Tx 77459
3
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM Credit Card Authorization Form Name on the Card: ____________________________ Type of Card: Visa ___ MC ___ AmEx ___ Discover ___ Other Account number____________________________ Expiration Date ________
Security Code_______
Billing Address____________________________ City, State, Zip____________________________ Charges to be charged the first of every month: Platinum Team: $145_____ Diamond Team: $120 _______ Emerald Team $65
________
Sapphire Team $90 ________ Tumbling Class w/Cheer $30 ___________ Tumbling Class $65 ___________
Amount to be Charged each month $_________
__________ initial
By signing this form, you authorize Crystal Webster-Sienna Spirit, LLC to charge your card for the amount listed above. Signed: ____________________________ Date: ___________ PAYMENTS: 1. Tuition payments will be charged the first of each month to the credit card on file. 2. Any rejected or charge back payments will have a $25 late fee. 3. All other payments (competitions and uniforms) that are not received on their due dates will automatically be charged to the credit card on file __________ initial 5. Any class cancellation must be in writing and presented by the 15 th of the month to avoid the next month’s tuition charge.
4
AGE
BIRTHDATE
DAY AND TIME OF CLASS
(Please note male or Female) 1. 2. 3. 4.
Mother’s name: Father’s name: Mother’s cell phone: Father’s cell phone: Address: City:
State & Zip: ___________________
Email Address: Emergency Contact: ______________________ Phone number: _______________________ How did you hear about Sienna Spirit? ___________________________________ Registration Fee $___35_________ Monthly Tuition $________________ *Registration fee is non-refundable and must be paid at time of enrollment. Tuition is due at the beginning of the month and considered late after the 15th. There is a $10.00 late fee per child if paid after the 15th.
1
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM SIENNA SPIRIT RELEASE, WAIVER OF LIABILITY, AND INDEMNIFICATION AGREEMENT In consideration for Sienna Spirit allowing my and/or my minor’s use of the SPRAI, its exercise programs, activities, and other services (collectively Facility), I, the undersigned, fully understand and agree to assume the sole risk of such use. Accordingly, I, on behalf of myself, spouse, heirs, estate, and assigns, expressly agree to release and hold harmless Sienna Spirit, and any of its present, former, or future subsidiaries, divisions, and affiliates, and its and their respective directors, officers, employees, contractors, agents, heirs, legal successors and assigns (collectively Released Parties) from and against any and all claims, suits, demands, losses, damages, expenses, or liability arising under any cause, or claimed under any theory of law, that may arise from any property damage or loss, injury, illness, or death, including that which may result to me and/or my minor, during or arising in any way from my and/or my minor’s use of the Facility, including but not limited to, any such claims arising from the negligence (whether active or passive, sole or concurrent) of any of the Released Parties. I understand and agree that it is my responsibility to assess the hazards presented by use of the Facility, and further agree that I am the ultimate judge as to whether I and/or my minor can use the Facility without risk or injury to ourselves. If a medical clearance must be obtained prior to my and/or my minor’s use of the Facility, I agree to consult a physician and obtain written permission prior to use of the Facility. I agree that I am responsible for monitoring my and my minor’s condition during use of the Facility, and if any symptoms occur, my minor or I will cease such use and seek assistance immediately. I understand that use of the Facility is voluntary and is not a requirement of Sienna Spirit. By signing this Release and Waiver of Liability, I affirm that I have read this form in its entirety, that I understand its content, and that I am signing it voluntarily. I also affirm that my questions regarding the Facility have been answered to my satisfaction.
____________________________________________________ Printed Full Name of Participant over age 18 (First, Middle, Last)
____________________________________________________ Signature of Participant over age 18 Date _______________ Indemnification for Minor Participants: The undersigned parent or guardian further agrees to indemnify, save and hold harmless the Released Parties from and against any and all claims, suits, demands, losses, damages, expenses, or liability arising under any cause, or claimed under any theory of law, that may arise from any property damage or loss, injury, illness, or death, that may brought, alleged, or incurred by or on behalf of the minor and during or arising in any way from the minor’s use of the Facility, including but not limited to, any such claims arising from the negligence(whether active or passive, sole or concurrent) of any of the Released Parties.
__________________________________________________________ Printed Full Name of Minor Participant (First, Middle, Last)
__________________________________________________________ Signature of Parent or Guardian (required if Participant is under age 18) _______________________________ Date
2
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM
SIENNA SPIRIT, INC. MINOR CONSENT AND ASSUMPTION OF RISK STATEMENT In consideration of membership in the Sienna Spirit Inc., the parent (s) and /or legal guardian (s) of the minor Participant named below agreed. 1. The parent(s) and/or legal guardian(s) to and will instruct the minor participating in any Sienna Spirit and/or members activity or event and regularly thereafter, that he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the instructor of such condition and refuse to participate. 2. I/We fully understand and will instruct the minor participant that: A. There are risks and dangers associated with participation in gymnastic and cheerleading events and activities including but not limited to those of bodily injury, partial and/or total disability, paralysis and death. B. The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe. C. These risks and dangers may be causes by the negligence of the participant or the negligence of others. D. There may be other risks not known to us or are not reasonably foreseeable at the time. 3. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis/or death, however caused or alleged to be caused in whole or in by the negligence of the Sienna Spirit, its members, officials, sponsors, advertisers, directors, agents and employees. 4. I/We agree that this Consent and Assumption of Risk Statement covers each and every event or activity sponsored by the Sienna Spirit, Inc.
I/We Have Read the Above Waiver and Sign It Voluntarily. ________________________________________
_
Signature/Relationship
Date
________________________________________ Parent or Guardian Signature/Relationship
Date
Printed Name of Participant: _________________________________________ Address of Participant: ______________________________________________ Printed Name of Parent or Guardian: _________________________________ Member Institution: Sienna Spirit LLC 9600 Scanlan Trace E. Missouri City, Tx 77459
3
Sienna Spirit Cheerleading, LLC CHEERLEADING AND TUMBLING REGISTRATION FORM Credit Card Authorization Form Name on the Card: ____________________________ Type of Card: Visa ___ MC ___ AmEx ___ Discover ___ Other Account number____________________________ Expiration Date ________
Security Code_______
Billing Address____________________________ City, State, Zip____________________________ Charges to be charged the first of every month: Platinum Team: $145_____ Diamond Team: $120 _______ Emerald Team $65
________
Sapphire Team $90 ________ Tumbling Class w/Cheer $30 ___________ Tumbling Class $65 ___________
Amount to be Charged each month $_________
__________ initial
By signing this form, you authorize Crystal Webster-Sienna Spirit, LLC to charge your card for the amount listed above. Signed: ____________________________ Date: ___________ PAYMENTS: 1. Tuition payments will be charged the first of each month to the credit card on file. 2. Any rejected or charge back payments will have a $25 late fee. 3. All other payments (competitions and uniforms) that are not received on their due dates will automatically be charged to the credit card on file __________ initial 5. Any class cancellation must be in writing and presented by the 15 th of the month to avoid the next month’s tuition charge.
4
