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MGA SUMMER CAMP & SUMMER CLASS REGISTRATION FORM 2015
1. Name
Sex
M F
Sex
M F
Sex
M F
2. Name
3. Name
Emergency
Contact
Address
Phone # (
DOB
Age:
DOB
Age:
DOB
Age:
)
Home (
)
Cell
)
(
Email:
City
Medical Conditions/Allergies
1.
Mom’s Name
Wk #
How did you hear about MGA?
Zip
2.
Dad’s Name
3.
Wk #
Photos may occasionally be taken of class participants. Is MGA free to use these in marketing publications without notifying/compensating you? _____YES _____ NO
CIRCLE YOUR WEEKS (weekly rate) OR CHOOSE YOUR DAYS (daily rate applies):
GYMNASTICS CAMP
(PRICE PER WEEK)
1
Week
2
Weeks
3 or 4
Weeks
SELECT CHOICE
5 or 6
Weeks
7 or 8
Weeks
½
$150
$130
$120
$110
$100
full
$280
$260
$240
$220
$200
Payment Options & Information:
I understand that this payment option locks registration
for July & August camp/classes. Schedule changes can be made 7
days IN ADVANCE but CREDITS ONLY will be given for drops
due to medical reasons w/dr’s note.
Camp SAVING: Jan=20% Feb=15% Mar=10% Apr=5%
Wk 1
Wk 2
Wk 3
Wk 4
Wk 5
Wk 6
Wk 7
Wk 8
July 6 -10
July 13 – 17
July 20 – 24
July 27 – 31
Aug 3 – 7
Aug 10 – 14
Aug 17 – 21
Aug 24 – 28
FULL/HALF
F
F
F
F
F
F
F
F
H am/pm
H am/pm
H am/pm
H am/pm
H am/pm
H am/pm
H am/pm
H am/pm
DAILY OPTIONS
M T W TH FR
M T W TH FR
M T W TH FR
M T W TH FR
M T W TH FR
M T W TH FR
M T W TH FR
M T W TH FR
BACK HAND SPRING CLINICS: July or August = $30 each
Jul 6 10 13 17 20 27 31 or Aug 3 7 10 14 17 21 24 28
Summer Class Special-8 weeks 1 HR classes ONLY $99 or 2 HR CLASSES $199
Summer Class choice (1 HR):
1st Child
Age:
Day:
TUES
THURS
Time:
Age:
Day:
TUES
THURS
Time:
Age:
Day:
TUES
THURS
Time:
(May 31st)
2nd Child
3rd Child
Registration & Insurance
Monthly Tuition
Pre-Team & Advanced Tuition
Current Students: No charge
1st Child = $85.00
1 x per wk (1.5 HOURS) = $130.00
CC# _____________________________________________Exp_______
New Students: $15/Family $20
2nd Child = $76.50
1 x per wk (2 HOURS) = $150.00
CASH/CHECK # ___________________________________________
Daily: $30 Half $56 Full
3rd Child = $72.25
2 x per wk (4 HOURS) = $265.00
Amount Due: _____________________________________________
BHS Clinics $30each
3 x per wk (6 HOURS) = $280.00
AMOUNT PD: _________________ Reg/Tuition must be paid in full.
Payment Details:
CLASS/CAMP/BACK HAND SP
I recognize that severe injuries, including permanent paralysis or death can occur in sports that involve height or motion: those activities include, but are not limited to gymnastics,
tumbling, dance and trampoline and team competition. Being fully aware of these dangers, I hereby give consent for my child/all children/family to participate in any and all
Monmouth Gymnastics Academy programs and activities and I accept responsibility for all risks associated with this participation. In consideration for their participation I, hereby,
for myself and my child or children and our respective heirs and successors covenant not to sue and forever release MGA, its officers, directors, shareholders, employees, contractors
and volunteers from all liability resulting in damages or injuries incurred as a result of participation. In the event of an accident or emergency I hereby authorize my child to be
transported to a hospital for medical treatment, and I hold MGA and its representatives harmless in the execution of such. I have read and understood this assumption of risk and
waiver of liability and medical authorization and I voluntarily affix my name in agreement.
Parent/Guardian Signature ______________________________________________________________________
Date _________________________________