ENROLLMENT FORM

CONTACT INFORMATION (Please Print Clearly) Students Name: _____________________________________ M/F: ___ Birthdate: __________ Age: ______ Address: ___________________________________________ City: ____________________ Zip: _________ Home Phone: __________________________ Email: _____________________________________________ Mothers Cell #: ______________________________ Fathers Cell #: _______________________________ Mothers Name: ______________________________ Occupation: __________________________________ Fathers Name: _______________________________ Occupation: __________________________________ Other Siblings Enrolled: ____________________________________________________________________ Person to Contact if Parents Unavailable: ________________________________ Phone: ________________ How did you hear about Studio D: ____________________________________________________________ POLICIES AND PROCEDURES (Please Initial)
_____ TUITION: Enrollment is by 8 week sessions paid two weeks in advance of each session to reserve a space in class. A discount is provided as our way of saying Thank You when you pay by this deadline. Tuition is nonrefundable, please read our Policies & Procedures for more information. _____ MAKE-UPS: If you miss your regular scheduled class for any reason, please call the gym IN ADVANCE to excuse your child. By doing so, you will have 2 weeks to schedule a make-up class at a different day and time or attend an Open Gym event. There is NO rescheduling make-ups. _____ PUNCTUALITY: We ask that you arrive 10 minutes early in consideration of parking and traffic delays. Every class begins with a warm-up period that is important to the physical and mental readiness of every student. _____ SAFETY RULES: Students may not be in the activity area or on any apparatus at any time prior to or after class. Parents, guests and siblings are required to wait in our observation areas before, during and after class. We ask for your cooperation in keeping noise to a minimum as our facility is small. If you have other children waiting, please control them and not allow them on wall, table or shelves. No restrooms by siblings or guest during classes. _____ PERMISSION TO BE PHOTOGRAPHED: At times, photos and video will be taken of students during classes and/or special events by parents of students, Studio D staff, and/or local media. By signing below I give my permission for my child(ren) and/or myself to be photographed and for the images to be used in promotional media and materials. _____ POLICIES & PROCEDURES: I have/will read these. They are located online and in the gym.

OFFICE USE

Session ________ Session #________ Other ________________________ Total___________ Trial Lesson ________________________ Time________

Enroll Date _______________________ Class 1 Day __________ Time __________ Class 2 Day__________ Time __________ Tuition _____________

Last Name ________________________ First Name ________________________ Registration _____________________ T Size ______ Rcvd. ______

I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE POLICIES AND PROCEDURES: PRINT NAME: ________________________________________ RELATIONSHIP: _________________ SIGNATURE: _________________________________________ DATE: ___________________________

PAYMENT OPTIONS
_______ Please charge my Visa/MasterCard automatically for each session (until otherwise notified) _______ Please charge my Visa/MasterCard only this one time Name On Card (please print): ______________________________________________________________ Card #: ____________ SVV code (found on back of card): __________________ ____________ ____________ ____________ Exp Date: ________________

Parent or Legal Guardian should sign the name of the minor if the minor is not old enough to sign the waiver themselves. Also have the parental consent portion signed by the Parent and/or Legal Guardian. This waiver, does NOT cover the parent. This waiver only covers the minor. If the Parent decides to participate in the same activity as the minor, please Make sure the Parent also signs the other Waiver in addition to this waiver.

Waiver for Minor Participants (under 18 years of age)

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT In consideration of participating in Open Gym | STEP | Private | Parents Play | Kindergym | Boys | FunNastics | Birthday Party I represent that I understand the nature of this Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity. I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the Releasees named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of my participation in the activity. I hereby release, discharge, and covenant not to sue Studio D, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the Releasees herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may incur as the result of such claim. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. _____________________________________________ Date:________________________ Printed name of participant PARENTAL CONSENT AND I, the minors parent and/or legal guardian, understand the nature of the above referenced activities and the Minors experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the minors account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minors behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasee may incur as the result of any such claim. ___________________________________________ Date:_______________________ Printed name of Parent/or Legal Guardian __________________________________________ Signature of Parent/or Legal Guardian
(Circle One)