Registration Form

Click here to: Download Legacy T&T Registration Form

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Legacy T&T Registration Form

Name ___________________________________________________________

Address ________________________________________________________

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Email ___________________________________________________________

Date of Birth ___________________________________________________

Home Phone ___________________________________________________

Cell Phone _____________________________________________________

Work Phone ___________________________________

Parents’ Names ________________________________________________

In case of emergency, please contact __________________________ __________________________________________________________________

Emergency Phone ______________________________________________

Insurance Carrier ______________________________________________

Policy Number _________________________________________________

Family Physician _______________________________________________

Physician’s Phone ______________________________________________

Special requirements (allergies, medications, illness, injuries, etc…) __________________________________________________________________ __________________________________________________________________

Program of Enrollment (please circle): Tots   Recreational   Adult Performance Team   Competitive Team

Days of Attendance per Week:

1         2         3         4          4+

Extra Length of Class (in hours):

1        1.5        2        2.5         3

MEDICAL WAIVER: The named student has my permission to attend the Legacy T&T program. In the event of injury or illness, I/we, parent or legal guardian, of the above-named child, or of ourselves, do hereby authorize Mig O’Hara, or a designated staff member of Legacy T&T as agent for the undersigned to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable by, and is rendered under, the general or surgical supervision of any licensed physician and/or surgeon. I/We will be fully responsible for any financial obligations incurred due to said treatment. ASSUMPTION OF RISK, RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT: Participation in gymnastics, dance, aerobic activities, trampoline and tumbling involves motion, rotation, and height in a unique environment, and such carries with it a reasonable risk assumption. Catastrophic injury, paralysis, or even death can result from improper conduct of these activities. I/We fully assume all such risks and all responsibility for losses, cost, and damages I/we incur as a result of my/our participation in these activities. I/We hereby release, discharge, and covenant not to sue and agree to indemnify, save and hold harmless Legacy T&T and its respective administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers, and if applicable, owners and leasers 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 further agree that if despite this release, I/we or anyone on my/our behalf makes a claim against any of the above “release,” I/we will indemnify, save and hold harmless each of the “releasees” from any litigation expenses, attorney fees, loss liability, damage, or cost any “releasee” may incur as the result of any such claim. ATTENTION: Once registered in this program, I, the undersigned, agree to pay the full tuition payments, as well as any other related fees, in a timely manner until I have notified Legacy T&T of my intention to discontinue classes. Written notice will be given two weeks prior to the discontinuance of classes, or in the event that the number of hours attended per week need to change.

• An annual, non-refundable registration fee of $50.00 is required upon registration and is due on or before January 1st of each consecutive year for recreational students and April 15th for competitive team. I have read and understand the Assumption of Risk, Release of Liability, and Indemnity Agreement, the Medical Waiver, and the policies of Legacy T&T. I agree to adhere to all policies set forth by this program.

Signature of parent or legal guardian ____________________________________________________________________ Date_______________________________