Loading...

Powerstation/Prodigy

Mat Space Rental Agreement

Powerstation/Prodigy Mat Space Rental Agreement

Membership agreements must be filled out one time annually.  Agreements are good Between August 1st and July 31st of the following year.

1. No Refunds. I understand that there are NO REFUNDS for mat space rentals once payment has been made for the space.

I Agree

2. No Food or Drink is allowed on the mats at any time.  Water is permissable but must be cleaned up by group if spilled.

I Agree

3. No shoes may be worn on the mats at any time.  Socks and barefeet are required on the mats.  Socks with grips on the bottom are encouraged for less slipping during practice.

I Agree

4. Code of Conduct/Personal Items Policy. I understand and agree that Powerstation Gym/Prodigy Wrestling Academy (PG/PWA) strives to maintain an atmosphere of mutual respect and that my child’s participation in all PG/PWA events and classes is a privilege that will only be continued when I or my child exhibit respectful and cooperative behavior.  Any explosive, argumentative, derogatory, or disrespectful displays to any PG/PWA staff member, other parent, or my own or another wrestler that does not positively contribute to the atmosphere in which PG/PWA is attempting to maintain and will be immediate grounds for dismissal from the PG/PWA program and property without refund or compensation.  This also extends to conversations to or overheard by other customers of PG/PWA. This is at the sole discretion of PG/PWA Staff. PG/PWA is NOT responsible for any lost/stoelen items that have been left behind, in our facility, by you or your child(ren).

I understand and agree to follow all rules set forth by Powerstation Gym/Prodigy Wrestling Academy (PG/PWA) concerning the wrestling room, gym facility, and restroom including staying in the matted area and out of restricted areas, not touching any equipment without permission from PG/PWA staff, supervising and accompanying non-wrestling children (brothers and sisters) for the duration of practice, not having any food or drink other than water in the gym or wrestling room, and making sure to check in at the front desk before every scheduled practice.  A list of facility rules can be received upon request and are posted throughout the facility. If anyone is in violation of these rules, they will be asked to leave the facility and pick their wrestler up at the end of practice.

I Agree

5. Marketing Release. I understand and agree that photos/videos taken of me or my child(ren) by Powerstation Gym/Prodigy Wrestling Academy and the their name(s) may appear in advertisement publications including marketing advertising, bulletin boards, promotional materials in print and online with our club website and social media.  These images and names will be used for Powerstation Gym/Prodigy Wrestling Academy purposes only, and will not be given or sold to outside companies or individuals.

I Agree

6.  As the Coach/Supervisor/Adult in Charge of the group using the facility, I take full responsibility for the group and the actions of the group during the time of the mat rental at Powerstation Gym/Prodigy.

I Agree
  

Today's Date: December 11, 2018

First Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*

Phone*
First Coach/Supervisor/Adult in Charge Date of Birth*
First Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
First Coach/Supervisor/Adult in Charge Signature*
Second Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Second Coach/Supervisor/Adult in Charge Date of Birth*
Second Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Third Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Third Coach/Supervisor/Adult in Charge Date of Birth*
Third Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Fourth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Fourth Coach/Supervisor/Adult in Charge Date of Birth*
Fourth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Fifth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Fifth Coach/Supervisor/Adult in Charge Date of Birth*
Fifth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Sixth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Sixth Coach/Supervisor/Adult in Charge Date of Birth*
Sixth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Seventh Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Seventh Coach/Supervisor/Adult in Charge Date of Birth*
Seventh Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Eighth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Eighth Coach/Supervisor/Adult in Charge Date of Birth*
Eighth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Ninth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Ninth Coach/Supervisor/Adult in Charge Date of Birth*
Ninth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Tenth Coach/Supervisor/Adult in Charge Name

First Name*

Last Name*
Tenth Coach/Supervisor/Adult in Charge Date of Birth*
Tenth Coach/Supervisor/Adult in Charge Group Information

School, Group, or Club Renting mat Space *
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Group Information

School, Group, or Club Renting mat Space *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver