Tumbling 2017

TUMBLING CLASSES

DROP IN FEE $15/DAY OR

**$40/Month-Sundays Only;

**$40/Month-Wednesdays Only OR

**$69/MONTHLY UNLIMITED

SUNDAYS 5 PM - 6:30 PM

WEDNESDAYS 4:30 PM - 6 PM

**An Automatic Payment Authorization form must be on file. (found below)

Athlete/Or Team Name *

First Name Last Name

Athlete Age or Range of ages for team *

Age of athlete as of August 31, 2017

To determine which level your athlete is at, we will use tumbling skills as our guide. The skills listed below should be done un-spotted.

Level 1 - Round-Off, Backbend-kickover

Level 2 - All of the above plus Running Round-Off, Backhandspring

Level 3 - All of the above plus Standing Backhandspring series, Running front handspring w/step-out, roundoff, Backhandspring, Back tuck, Running Front Punch

Level 4 - All of the above, plus layouts, standing back tuck

Level of Athlete(s) *

Level 1 Level 2 Level 3 Level 4 Don't know

Are you member of Xtreme Cheer or Dance? *

Yes No In the process I would like more information on becoming a member. I am attending with a visiting team

Parent or Team Contact

First Name Last Name

Parent/Team Contact Email *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number

Acknowledgment of Risk

I/We full understand that cheerelading and dance invloves motion and height, and that any physcial activity, including cheerleading and/or dance, that involves motion and/or height can result in serious permanent injury, disabitlity or death.

Permission to Participate

With knowledge of the risk of possible injury, disabiltiy or death from participation in cheerleading and dance, I/We the parent(s)/legal guardian(s) or the person of ______________________, (the student), do hereby grant permission for the sutdent to participate in cheerleading and/or dance at Xtreme Cheerleading, LLC.

Assumption of Risk and Release from Liability

I/We hereby assume all risks for the student's personal injury, including disabiltity and/or death, sustained by the student while participating in cheerleading or dance at Xtreme Cheerleading, LLC or while on it's premises. I/We realease Xtreme Cheerleding, LLC, its directors, instructors, employees, of and from any and all liability any of them may have for any injury, including disability and/or death, sustained by the student without limit and without regard to the cause or causes thereof or the negligence of any party or parties.

Consent to Medical Care

I/We do hereby authorize any adult director, instructor, or employee of Xtreme Cheerleading, LLC who has care and control of the student to consent to any medical treatment of the student when I/we cannot be contacted, in the judgemtn of any prospective treating doctor, is immediately and medically necessary to treat and injury sustained by the student.

Indemnity and Hold Harmless

I/We do hereby agree to indemnify Xtreme Cheerleading, LLC, it directors, instructors and employees and hold them harmless from any claims, demands, and causes of action made against them or expenses they may incur in connection with any injury, including disability and/or death, sustained by the student or in connection with any medical care received by the student.

Name *

First Name Last Name

By typing my name above, I am agreeing to all statements on this registration form.

All monies paid are non-refundable.

My Products

Tumble Class/Session $ 15.00

Quantity

Tumble Class / Unlimited Monthly ($51 savings) $ 69.00

Quantity

Tumble Class Wednesdays Only $ 40.00

Quantity

Tumble Class Sundays Only $ 40.00

Quantity

Subtotal: $ 0.00 Tax: $ 0.00 Total: $ 0.00