Kingdom Gymnastics, LLC
2000 Memorial Drive (Mailing: 2002 Memorial Drive) St. Johnsbury, Vt. 05819
Registration Form 2024- 2025
Student’s Name:________________________________________________sex:____________age:___________dob:______________
Address:_____________________________________________________________________phone#_________________________
Mother’s Name:________________________________________work ph#_____________________cell#___________________
Father’s name:_________________________________________work ph#_____________________cell#____________________
E-mail address:_________________________________________________________________________________________________
Emergency Contact Name and ph#____________________________________________________________________________
How did you hear about us? Facebook Word of Mouth Gym Birthday Party Other
Payment Policy: Payment is due the first week of each session for students in the class program, or the first of the month if your child is on the Team Program. There will be a $10.00 late fee for EACH week FULL payment is late. There will be a $25.00 charge for returned checks. We have automatic enrollment for our class students until the end of Session 5. If your child is going to drop a session or not continue, we must be notified by the deadline listed in the Parent Handout, or you will be responsible for the tuition payment for that session. Refer to the Parent Handout for the list of session dates and deadlines to drop a session. USAG Team Members are required to be enrolled for the entire season (Sept – April).
Registration Fee: The annual registration fee is $35.00 per student and is due at the beginning of each program year (September). Students who enroll in the middle of the year are also charged $35.00 for the registration fee, which is only good until the following September. This fee is non-refundable.
Family Discount: $10.00 will be taken off class tuition for each sibling, after the first child is enrolled at the regular price. This does not apply to the Team Program.
Make-ups: There will be no refunds for missed classes including cancellations due to weather, unforeseen circumstances, or mandatory closures due to declared “National or State Emergencies”. If the gym cancels classes due to weather, you will be provided with a time to make-up the class. If the gym is forced to close for “State of Emergencies”, we will make every effort to provide make-up classes, but make-ups will not be guaranteed. If your child misses a class for any reason, he/she can attend one Open Gym for free, as a make-up. Under normal circumstances, the free pass to Open Gym is only good until the end of the session that follows the missed class.
Use of Images/Name Identification: The undersigned authorizes Kingdom Gymnastics to use images of the students/parents, both with and without name identification, for Kingdom Gymnastics publicity, promotional and advertising purposes.
______________________________________(signature of parent/guardian)
Medical/Developmental: It is important that Kingdom Gymnastics be made aware of any medical or developmental situation that our students may have. Please advise us if your child has a medical problem that requires a doctor’s care, or a developmental problem that is currently being treated. Specific examples include hearing loss, heart problems, asthma, diabetes, autism, LD, ADD, ADHD, scoliosis, arthritis, epilepsy, etc. Please write any pertinent information below. If your child has any physical condition that may impair his/her ability to engage in activities, it is your responsibility to obtain a physician’s statement describing any limitations to participate in this program.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Rules and Obligations: For the safety of your child, please be on time when dropping off and picking up your child. No child will be allowed to leave the gym to wait for their ride or to get picked up. You must come inside the gym to get your child when class is over. No food, drinks other than water bottles, or gum is allowed inside the gym area. Your child is obligated to follow gym rules regarding safety, use of facilities and respect toward students and coaches. Kingdom Gymnastics reserves the right to cancel the enrollment of any child who becomes uncontrollable or consistently violates safety rules. NO refunds or credits will be given.
Parent/Guardian Waiver and Release: I fully understand that Kingdom Gymnastics staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby authorize and release Kingdom Gymnastics to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by Kingdom Gymnastics staff, to seek additional medical help and/or call an ambulance. I am aware that my son/daughter will be engaging in physical exercise involving activities that could cause injury to them. I agree that my child is voluntarily participating in these activities and we are assuming all the risks of injury, including total disability, paralysis and even death that might result. I hereby agree to waive any claims or rights against Kingdom Gymnastics, LLC and it’s staff for any liability, loss, costs, damage, medical expense, long-term care, emotional distress or compensation that might incur as a result of these activities. I also agree to waive any claims against Kingdom Gymnastics should my child, myself, or any member of my family, be diagnosed with Covid-19, or any other infectious disease, that could possibly be traced to another person attending Kingdom Gymnastics, whether it be a student, coach, staff member or other parent.
I have read, understand, and agree to all the policies listed above. By signing this form, I have acknowledged that I have received the Parent Handout.
Parent/Guardian Signature______________________________________Date____________
