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MANDATORY PARTICIPANT REGISTRATION FORM

LIABILITY RELEASE AND INDEMNIFICATION:

Prior to participation, this form must be signed by at least one of the participant's parents or legal guardians if the participant is not yet 18 years old. Participant's signatures are required if 18 years of age or older.

In consideration of the services of Sagamore Gymnastics, Inc., their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (herein after collectively referred to as "SAG"), I hereby agree to release, indemnify and discharge SAG, on behalf of myself, my spouse, my children, my parents, my heirs, my assigns, personal representative and estate as follows:

1. Acknowledgement. I acknowledge that I am allowing the participants to participate in sports activity, inflatable devices, or any other amusement device activity, trampoline, class, competition, team, including non gymnastics activities such as dance, cheerleading, and playground activities (herein after referred to as the "activity"). I acknowledge that participation in these activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I, and if I'm not yet 18 years old, my parents or legal guardians, agree to be bound as follows (the term "I" in this release refers to both the participant and his or her parents or legal guardians);

2. Assumptions of Risk. I understand that the Activity involves risks of serious bodily injury, including permanent disability, paralysis and death which may be caused by the participant's actions or in-actions, those of others participating in the Activity, the conditions in which the Activity takes place, the negligence of the "released" parties named below, or other causes. I further understand that there may be other risks not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, cost, and damages that may result from the Activity. I hereby give my approval of and consent to participate in the Activity. My participation in this Activity is purely voluntary and I elect to participate in spite of the risks. I assume all risks and hazards incidental to the Activity and to transportation to and from the Activity;

3. Representation of Ability to Participate. I understand the nature of the Activity, and I represent that the participant is qualified, in good health, and in proper physical condition to participate in the Activity. Should I ever believe that any of the above representations have become untrue, or if I should ever believe that the Activity is not safe or is no longer safe for the participant, then it will be my responsibility immediately to discontinue the participation in the Activity. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bare the costs of such injury or damage to myself;

4. Release. I hereby release, acquit, covenant not to sue, and forever discharge SAG, its owners, officers, administrators, employees, agents, volunteers, sponsors, advertisers, coaches, and supervisors and the owners or lessors of any facilities within which the Activity is conducted, their respective agents and employees, and all other persons providing facilities or assisting in the conduct of the Activity and in the transportation of the participant's to and from the Activity (collectively the "Released Parties") of and from any and all actions, causes of action, claims, demands, liability, losses or damages of whatever name or nature, including but not limited to those arising from or in any way related to the negligence of any of the Released Parties, that arise out of or are connected in any way to the participant's participation in the Activity and the transportation of the above named participant to and from the Activity (collectively the "Released Claims");

5. Indemnification. I will defend, indemnify and hold harmless the Released Parties from (that is, to reimburse and be responsible for) and loss or damage, including but not limited to costs and reasonable attorney's fees (including the cost of any claim I might make or that might be made on my behalf or the participant's behalf that is released in this document), arising out of or connected in any way with any of the released claims; 

I HAVE READ AND UNDERSTOOD THIS ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS, REPRESENTATION OF ABILITY TO PARTICIPATE, RELEASE AND INDEMNIFICATION. I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I AM GIVING UP SUBSTANTIAL RIGHTS, I AM EXECUTING THIS DOCUMENT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE. 

 

PAYMENT AGREEMENT AND INFORMATION:

SIGNING THIS AGREEMENT CONFIRMS YOU HAVE READ, UNDERSTAND AND AGREE TO ALL OF THE PAYMENT POLICIES AS DESCRIBED.

1. Withdrawal Notice.

  • 15 business days WRITTEN NOTICE of withdrawal is required in order to remove your gymnast from their session.
  • If you withdraw on auto payment, there are NO REFUNDS.
  • Full or split payments will have an ADJUSTED REFUND from the date of withdrawal.
  • Tuition is non-transferable between sessions. Tuition can not be transferred from one person to another, this includes siblings.
  • All makeups are void after notice of withdrawal is given.

2. Makeup Policies.

  • Makeup classes are a courtesy, not an obligation.
  • There are no refunds for missed classes. There are no makeups for previously scheduled makeups.
  • Makeups must be scheduled by phone or in person with our office staff. Do not arrive for a makeup without scheduling it first.
  • You can make up a maximum of 8 classes for the 10 month session: 4 before January 1st and 4 before June 1st. Makeups must be done in the session in which the classes were missed. Makeups are not transferable between sessions. Makeups can not be transferred from one person to another, this includes siblings.
  • There are no makeups for pre team or team unless the gym is closed due to weather conditions.
  • Only members that are currently enrolled can make-up classes.

3. Apparel Policies.

  • All gymnasts must wear a leotard (exceptions: Mommy and Me, Tiny Tumblers, Ninja Classes and Trials).
  • No jewelry is permitted except for stud earrings.
  • If you or your child pulls the tag off our apparel that is for sale or takes it home, it is understood that you are purchasing that apparel and your credit card on file will be charged or you will be billed accordingly.

4. Pre-team and competitive team payment policies.

  • If your child is a Pre-Team or Competitive Team member it is understood that they have made a commitment to the team for the competitive season (July through June of each year). Pre-Team and Team tuition is due by the 1st of the month, every month, regardless of vacations, injuries and attendance. A 20 day written notice is needed to cancel your child’s enrollment in the Pre-Team and Competitive Team programs, otherwise you are responsible for your monthly tuition. Apparel and meet fees must be paid upfront. Any meet fee that Sagamore pays on your behalf will be charged to your credit card on file unless alternate payment is received. ALL TEAM MEMBERS MUST HAVE A CREDIT CARD ON FILE.

5. Misc.

  • Declined credit cards or bounced checks will have a $25 processing fee.
  • Upon registration, a $40 yearly, non-refundable membership fee is due. Membership runs from September through August.
Please select who will be participating...
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First Participant Name

First Name*

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information

Age *

Home Phone Number *

Cell Phone Number *

Mother's Name

Father's Name

Does the participant have any special needs and/or allergies that you would like us to be aware of? *
First Participant Signature*
Participant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Physical Activity Readiness Questionnaire
Has the participant had a physical examination in the last 3 years (Sagamore recommends that every student complete an annual physical examination)*
No
Yes
Does the participant have any special needs and/or allergies that you would like us to be aware of?*
No
Yes
Does the participant have chest pain brought on by physical activity?*
No
Yes
Has the participant developed chest pain within the past month?*
No
Yes
Does the participant tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
Does the participant have a bone or joint problem that could be aggravated by gymnastics?*
No
Yes
Does the participant have an infectious skin disorder?*
No
Yes
Does the participant have uncontrolled asthma?*
No
Yes
Does the participant have a convulsive disorder?*
No
Yes
Does the participant have a history of a liver disorder, spleen disorder, kidney disorder, or detached retina?*
No
Yes
Are you aware, though your own experience or a doctor's advice, of any other physical reason against exercising without medical supervision?*
No
Yes
Has a doctor ever said the participant has a heart condition and recommend only medically supervised physical activity?*
No
Yes
Is the participant currently or recently recovering from a significant illness?*
No
Yes
Has a doctor ever recommended medication for blood pressure, heart condition, or other disorder that could influence ability to perform gymnastics?*
No
Yes

List any medical conditions the participant has that we should be aware of
Photo Sharing
May we use the participant's photo on our website or on social media (Facebook, Instagram, etc)?*
No
Yes
Today's Date

Enter today's date *
SELECT ONE OF THE FOLLOWING PAYMENT OPTIONS
Please read each of these options carefully and select the one you want (pre-team tuition and team tuition are billed the first of every month):*
PAY IN FULL. Your full fee is due at registration.
SPLIT PAYMENTS. (NOT AVAILABLE AFTER DECEMBER 31ST) Your first payment is due upon registration, second payment due Jan 2019. YOU MUST KEEP A VALID CREDIT CARD ON FILE TO USE THIS OPTION.
AUTO PAY. There are NO REFUNDS for this option. You will pay 5 bi-monthly installments which will be billed as follows: the first 4 installments at 22% of the tuition and the 5th at 12%. There is a $5 surcharge for each payment. You card will automatically be charged the first payment upon registration and the balance of payments on Nov. 1, Jan. 1, Mar. 1, and May 1. Upon notice of withdrawal you will be obligated to finish out the classes remaining from your most recent payment. Without notice of withdrawal, you will continue to be charged for your child's tuition.
YOUR CREDIT CARD INFO
Credit Card Type (we do not accept American Express)*

Card Number *

Name on Card *

Expiration Date *

Security Code *

Billing Street Address *

Billing City, State (example: Syosset, NY) *

Billing Zip Code *

Today's Date *
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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 Information

Age *

Home Phone Number *

Cell Phone Number *

Mother's Name

Father's Name

Does the participant have any special needs and/or allergies that you would like us to be aware of? *
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.


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