TCT Summer 2010 Daycamp Enrollment Form

Just print, fill in the blanks and mail, fax, or drop it off at the gym.  Registration deadline is the Wednesday prior to the first day of camp.
Twin City Twisters, 9001 123rd Ave. N., Champlin, MN 55316, p. 763-421-3046, f. 763-421-1448

Name ______________________________ Gender:   M   F       Birthdate ___/___/___
Address _______________________________________________
City______________________________ State_____ Zip_________
Home phone (____)_______________ Work phone (____)______________
Parent(s) name ______________________________________
In case of emergency, contact (name): _____________________________________
Contact phone # (____)______________ Insurance Company ________________________

Check which week you are enrolling in:

Daycamp enrollment fee:
$190.00 per week/child
$45.00 per day/child (single day enrollment opens the Monday prior to the start of camp)
Payable by: Cash, Check, or Credit Card

If Faxing, please include:
Card Type: Visa Mastercard Discover
Name on card: _______________________________
Card # _____________________________________
Exp. _____________

Parent Permission: (must be filled out and signed before first day of camp)
_______________________ has my permission to participate in a gymnastics camp at Twin City Twisters Gymnastics.
I give permission to Twin City Twisters Gymnastics and/or an appropriate medical facility to make whatever emergency (e.g. first aid, disaster evacuation) measures as judged necessary for the care and protection of my child while under the supervision of Twin City Twisters Gymnastics. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resource (Police, Rescue Squad) deems it necessary. The child will be transported at my expense. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician, and/or other adult acting on a parent's behalf. I am aware that there are risks involved and that serious injury, and even death may result with improper conduct of this activity. I have instructed my child to follow directions.
I fully disclaim, waive, and discharge Twin City Twisters Gymnastics, their instructors, and directors from all claims with regard to any personal injury that may be incurred by my child during this class.
My child is in good physical health, and there are no medical conditions which would limit his/her participation in class.

Parent/Guardian Signature(s) _________________________________ Date _____________