Southern Elite Gymnastics Registration for Minor
4680 Morton Road, Alpharetta, GA 30022
Registration Month/Day/Year __________________________/__________________
Student Name(s): ________________________________________________________
Age: ____________ Date of Birth: __________________________________________
Parent’s Name: __________________________________________________________
Address: _______________________________________________________________
City: __________________________________ Zip: ____________________________
Phone# (H) __________________________ Mom (W) _________________________
Dad (W) _____________________________ Mom (C) __________________________
Dad (C) ______________________________
E-Mail: (Please Print Neatly for Monthly Billing Purposes)
_______________________________________________________________________
Emergency Contact: _____________________________ Phone __________________
Anything we need to know about your child (Asthma, Allergies, etc) _____________
________________________________________________________________________
Who is authorized to pick up your child: ___________________________________
_______________________________________________________________________
Enter Program Registered for each child:
Class Assignment: ________________________Day: ___________Time:___________
Class/ or School Pickup: ___________________Day: ___________Time:__________
How did you hear about us? ______________________________________________
(PLEASE READ & SIGN SECOND PAGE)
segagymnastics.com
PLEASE INITIAL & SIGN SEGA RULES & POLICIES
(Initial 1-5)
_________ FEE SCHEDULE: Classes are based on a 4 week average calendar month. Some months have 5 weeks of class. Classes are ongoing all year. SEGA is closed for the major holidays following the Fulton County School schedule, plus Memorial Day and July 4th. No make-up classes when SEGA is closed for holidays.
A NON-REFUNDABLE yearly Registration fee of $60 is due per family at sign up.
_________ TUITION IS DUE THE FIRST WEEK OF EVERY MONTH.
LATE FEE of $15.00 is applied after the 7TH. 3.5% IS ADDED FOR CREDIT CARD PAYMENTS. For simplicity consider bank drafts mailed prior to the 7th.
** Please put payments in SEGA tuition box (at front desk) the 1st week monthly.
_________ WITHDRAWAL POLICY: If you wish to withdraw from SEGA’s program, a two week written drop notice is required. Payment is due through the 2 week period. SEGA does not assume your child has left our program. Drop notices may be sent by e-mailing segagymnastics@mindspring.com , or a drop form found at the front desk. ***For immediate withdraw, the drop fee due is $25.00.
_________ MAKE-UP CLASSES: Make-up classes are offered if you miss due to sickness, death in the family, etc. These classes must be made up within a month of the absence. SEGA must be informed in advance to schedule a make-up class. Make ups may be scheduled as an additional class during the week as long as there is availability in that class. WE WILL NOT PRO-RATE into the next month for MISSED CLASS. No Make Up’s will be ALLOWED After a Child Drops from Class. ** No Make Up’s allowed for SEGA holiday closings.
_________ DELINQUENT ACCOUNTS: THERE WILL BE A $15.00 SERVICE CHARGE FOR ALL RETURNED CHECKS. For Accounts greater than 30 days past due your gymnast will not be allowed to participate in class or team practice and a parent is called. Accounts over 30-60 days delinquent result in termination of class, and payment due may be submitted to a collection agency or small claims.
*After School payments due weekly, if 2 weeks late, child will not be picked up.
EMERGENCY MEDICAL RELEASE/WAIVER AND RELEASE OF LIABILITY
THE UNDERSIGNED, BEING THE PARENT OR GUARDIAN OF THE STUDENT, ______________________________ (child’s name), DOES HEREBY AUTHORIZE SOUTHERN ELITE GYMNASTICS ACADEMY, ITS COACHES, TRAINERS, OR ANY MEMBER OF ITS STAFF, TO OBTAIN EMERGENCY MEDICAL TREATMENT FROM ANY PHYSICIAN, HOSPITAL, OR OTHER QUALIFIED MEDICAL PERSONNEL AT OUR FACILITY AS NEEDED IN THE EVENT OF ACCIDENT OR INJURY. THE UNDERSIGNED FURTHER STATES THAT THE ABOVE MENTIONED STUDENT IS IN GOOD HEALTH AND IS NOT SUFFERING FROM ANY MEDICAL OR PHYSICAL IMPAIRMENT, EXCEPT_____________________ (Please Initial Here)____________________. THE UNDERSIGNED IS FULLY AWARE OF AND APPRECIATES THE RISKS, INCLUDING THE RISK OF POSSIBLE SERIOUS INJURY, AS WELL AS OTHER DAMAGES AND LOSSES ASSOCIATED WITH PARTICIPATION IN GYMNASTICS ACTIVITIES AND TRAINING. THE UNDERSIGNED FURTHER AGREES THAT SEGA, ITS OFFICER, EMPLOYEES, AGENTS, DIRECTORS, COACHES, TRAINERS, OR ANY MEMBER OF ITS STAFF SHALL NOT BE LIABLE FOR ANY LOSSES OR DAMAGES OCCURRING AS RESULT OF PARTICIPAITON IN GYMNASTICS ACTIVITIES AND TRAINING
I HAVE FULLY READ THE ABOVE INFORMATION, AND AGREE TO ABIDE BY ALL POLICIES, AND LEGAL TERMS.
________________________________________________________Date____________________ Parent Signature