Annual Registration Form
Annual registration fee is $60.
Date:___________
Total due upon enrollment:___________
Parent Information
Parent Name(s):
Mailing Address:
Phone Number(s):
Email:
Emergency Contact:
Emergency Contact Phone:
Relationship:
Participant Information
1. Name:
Class(es):
Date of Birth:
Age:
Allergies:
Cinch Bag (circle color): Blue / Green
2. Name:
Class(es):
Date of Birth:
Age:
Allergies:
Cinch Bag (circle color): Blue / Green
Physician:
Physician Phone:
1/2014
M / F
M / F
1
Payment Policies & Options
Unless otherwise noted, each seasonal session includes 12 classes. Due to holidays and scheduled gym closures,
sessions may be longer than 12 weeks in duration. Gym closure dates are posted in the gym and on the website.
Payment is due on the 25th of the month preceding the start of each session.
Please select a payment option:
Autopay
Cash/Check
(Autopay is required for Gold, Platinum and Team participants.)
Please complete the authorization below regardless of the selected payment option.
Credit Card Type (circle):
VISA
Master Card
AMEX
Discover
Card number :_______________________________________________ Exp date: ________________
Cardholder's name: ___________________________________________________________________
Cardholder's billing address: ____________________________________________________________
Signature: __________________________________________________________________________
Relationship if not parent's card:_________________________________________________________
Payment Policies:
Tuition is charged to the credit card authorized above when payment is not received within 10 days of the due date.
A fee of $25 is assessed for all payments not received by the due date and for all returned checks. Axis Gymnastics &
Sports Academy does not pro-rate or credit tuition for missed classes. Students with an outstanding
balance will not be allowed to participate.
initial______
Rolling Enrollment:
Current students are automatically enrolled in the next session unless the front desk is notified of
withdrawal in writing according to the Withdrawal Policy below.
initial______
Absence & Withdrawal Policies
ABSENCES - Tuition is not prorated or refunded for students who miss class due to personal reasons. Full tuition
payment is required during extended travel to hold a space for your child. Students who would like to
make up a class may attend an Open Gym for free for additional practice time.
initial ______
WITHDRAWAL - Withdrawals from class must be submitted in writing at least 2 weeks prior to the desired drop date.
Accounts are responsible for two weeks of tuition after the date when written notice is received. Verbal notice to
coaches or via phone is not valid and will not be accepted. A drop form that can be emailed
to the front desk is available on the website.
initial ______
I understand and agree to the above stated payment, absence and withdrawal policies.
__________________________________________________________________________________________________
Signature
1/2014
Date
2
Release and Indemnification
 I acknowledge, agree and am fully aware that gymnastics and related activities involve many risks, dangers and hazards, including but not limited to
height and rotation in a unique environment. I recognize that there are several known and unknown dangers and risks to the physical well being of my
child/children ("child") associated with activities of this type. I agree, acknowledge and consent that my child is physically able to participate in the
gymnastics and related activities. I agree, on behalf of myself and my child, to waive, release, and discharge from any and all liabilities, claims, actions,
damages, costs, or expenses of any nature whatsoever, whether in law or equity, known or unknown, both present and future, asserted by others, by
me, by my child, by my child’s estate, executors, heirs, or assigns, including my or my child’s insurers, against Axis Gymnastics & Sports Academy, L3C
(“Axis”) and any of its directors, officers, members, managers, affiliates, employees, volunteers, representatives, and agents, event holders, event
organizers, event sponsors, event directors, and property owners (the “Releasees”), arising out of or in any way related, directly or indirectly, to my
child’s participation in the gymnastics and related activities, including those related to the Releasees’ own negligence.
 If my child requires emergency medical attention, I give permission to the staff of Axis to seek or administer the necessary medical care. I understand
that they will make every effort to contact me and/or the emergency contact(s) listed above.
 I agree (for my child, myself and my heirs, executors, administrators, legal representatives, assignees, and successors in interest), to indemnify and hold
harmless the Releasees from any harm, injury, damage, or loss which my child may suffer, cause and/or contribute to while participating in gymnastics
and related activities, including those caused by Releasees’ own negligence.
 I understand and agree that I am solely responsible for transportation of my child to and from Axis and have read and agree to the Axis policy regarding
children riding the bus to Axis from school.
 I understand that my child may participate in offsite activities sponsored by Axis and will ride the Teton County START Bus to and from those offsite
activities. My child will be accompanied by Axis staff at these offsite activities (including bus rides). I agree, on behalf of myself and my child, to waive,
release, and discharge from any and all liabilities, claims, actions, damages, costs, or expenses of any nature whatsoever, whether in law or equity,
known or unknown, both present and future, asserted by others, by me, by my child, by my child’s estate, executors, heirs, or assigns, including my or
my child’s insurers, against Releasees, arising out of or in any way related, directly or indirectly, to my child’s participation in these activities as well as
their transportation on the Teton County START Bus, including those related to the Releasees’ own negligence or the negligence of any third party
involved in these offsite activities.
 If, in Axis’ judgment, my child is enrolled in a program not appropriate to his or her age/ability level, Axis RESERVES THE RIGHT TO MOVE MY CHILD to
the appropriate program when space is available.
 I consent, on behalf of myself and my child, to the use by Axis, or anyone it authorizes, of any and all photographs, tapes or other representations, and
any reproductions thereof for purpose of promotion (including sale, publication, display and exhibition) without compensation. I also consent, on behalf
of myself and my child, to the use of my child’s name in connection with any such materials. I agree, for myself and my child, that such materials and
negatives shall constitute Axis property, with full right of distribution by Axis concerning the subject matter hereof, and that this agreement supersedes
and replaces all prior negotiations, proposed agreements, agreements or representations, whether written or oral.
 I acknowledge that neither Axis nor any of the Releasees has made any representation, warranty, promise or covenant whatsoever, express or implied,
not contained in this agreement, to induce me to execute this agreement.
 I agree that this Agreement, and any claims related to this agreement, whether such claims are in the nature of tort, contract, or otherwise, shall be
construed in accordance with the laws of the State of Wyoming.
 I agree, for myself, my child, and my child’s estate, that all claims of whatever type arising out of, or related in any way to, this agreement, shall be
brought exclusively in the courts of the State of Wyoming, County of Teton, or, if I or my child or my child’s estate can acquire jurisdiction, in the United
States District Court for the District of Wyoming. I further agree, for myself, my child, and my child’s estate, that if any action or proceeding arising out
of, or related in any way to, this agreement is brought in any other court or forum, the action or proceeding shall be dismissed with prejudice and the
party bringing the action or proceeding shall pay the other party’s legal fees and costs.
 The release and indemnification provisions above shall be construed broadly to provide a release and waiver to the maximum extent permissible under
applicable law. If any part of the release and indemnification provisions shall be found by a court of competent jurisdiction to be void or unenforceable
for any reason, that finding shall in no way affect (to the maximum extent permitted by applicable law) the remainder of the release and indemnification
provisions.
 I represent and warrant that I am the parent and/or guardian of the student listed above.
I represent and warrant that: (i) I have read this agreement carefully; (ii) I understand that this agreement contains a release of liability, including liability
caused by Releasee’s own negligence, which will legally prevent me, my child, my child’s estate, my or my child’s insurers, and/or any other person, from
recovering damages in the event of injury to or death of my child arising out of or related in any way to his/her participation in gymnastics and related
activities; (iii) I have full right and authorization to waive, relinquish and compromise those claims as set forth above; (iv) I have not previously assigned,
conveyed or pledged to any third person and claims released by this agreement; (v) I am knowingly and voluntarily releasing and waiving claims against the
Releasees as set forth above; (vi) I have executed this agreement voluntarily; and (vi) this agreement is binding upon me, my child, my child’s estate, my
child’s insurers, anyone claiming on behalf of or through my child, and our respective heirs, assigns and legal agents or representatives.
Please print Name of Parent or Guardian
1/2014
Signature
Date
3