Registration Form For New Members

New Member Registration Form
SPRING 2010

Please print out this form and either fax or mail it to Twin City Twisters
FAX: 763-421-1448
MAIL: Twin City Twisters, 9001 - 123rd Ave. N., Champlin, MN 55316
Phone: 763-421-3046
Spring Session 2010 Session Classes Days & Times
Current Session Days & Times

Last Name _____________________________

Address _______________________________

City ______________________ State ____ Zip _________

Mother's Name ____________________ Phone (H) ___________________ (W) ___________________

Father's Name ____________________ Phone (H) ___________________ (W) ___________________

Health Insurance Company ____________________________ Policy # _________________________

How did you learn about us?

Have you attended TCT before?(Please Circle) Yes / No

Email: _________________________________________________

1st Child:

Name ____________________________ Birthday _______________ Age ____

1st choice: Class Level _____________________ Day _______________ Time ________

2nd choice: Class Level _____________________ Day _______________ Time ________

3rd choice: Class Level _____________________ Day _______________ Time ________

2st Child:

Name ____________________________ Birthday _______________ Age ____

1st choice: Class Level _____________________ Day _______________ Time ________

2nd choice: Class Level _____________________ Day _______________ Time ________

3rd choice: Class Level _____________________ Day _______________ Time ________

FEES:		\|	Tuition Rates per 12 Week Session Includes Spring Show (subject to change)
1st Child	$_________	\|	45 minute class	$165.00
2nd Child (15% discount)	$_________	\|	55 minute class	$198.00
3rd Child (30% discount)	$_________	\|	1 hour 25 minute class	$260.00
4th Child (30% discount)	$_________	\|	1 hour 55 minute class	$321.00
Annual Fee	$ 40.00	\|	1 hour 55 minute class	$291.00
SubTotal	$_________		2 hours 25 minute class	$348.00
Coupon	$-________	\|	2 hours 55 minute class	$400.00
Total Due	$_________	\|	One child signed up for multiple classes will receive 10% off the second class and 15% off the third class. High School class prices DO NOT include Spring Show Fees or participation
		\|

If sending by fax

Name as it apears on credit card: _________________________________
type of credit card (circle one) | American Express | Visa | Master Card | Discover
Card #: ____________________________________ Expiration date: ________
Thank you!!

Reminder: A down payment of 50% is required to register. Full payment is due by the first class. There will be a $10.00 late fee applied for each month that the balance remains unpaid. We do not give refunds or credits for missed or dropped classes after the session begins.

Parent Permission: (must be filled out and signed before first class)

_______________________ has my permission to participate in a gymnastics class/field trip at Twin City Twisters Gymnastics. 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 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 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.

Date______________ Signature____________________________(parent or guardian) Print Name ________________________
Allergies_______________________________ Medications__________________________________________
Special Note_________________________________________________________________
__________________________________________________________________________
Phone Number in case of emergency_____________________________