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Sokol Gymnastics, LLC

Auto Pay Form

SOKOL Elite Gymnastics Tuition Policy Agreement & Auto Pay Form

I agree to pay my child’s monthly tuition as follows: Team members: Your Card will be charged on the last day of each month prior to the 1st of the new month. Recreational students: Your card will be charged on the 1st of each new month. I understand that my child will not be allowed to practice until the payment has been received in the office

By signing below, you agree to allow SOKOL Gymnastics LLC to charge your card on the assigned date as stated above. Requests to stop auto payment must be submitted in writing, to office@sokolelitegymnastics, no later than the 25th of the month prior to withdrawal or regular tuition will run. There are NO EXCEPTIONS or REFUNDS if request to stop auto payment is made after the 25th.


Auto Pay Information:

Student Name *

Name on Card *

Email *

Cell # *

Card # *

Card Exp Date *

CVV *
Parent 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:*
First Parent Name

First Name*

Last Name*
First Parent Age Acknowledgment*
First Parent Date of Birth*
I certify that I am 18 years of age or older
First Parent Signature*
Second Parent Name

First Name*

Last Name*
Second Parent Date of Birth*
Third Parent Name

First Name*

Last Name*
Third Parent Date of Birth*
Fourth Parent Name

First Name*

Last Name*
Fourth Parent Date of Birth*
Fifth Parent Name

First Name*

Last Name*
Fifth Parent Date of Birth*
Sixth Parent Name

First Name*

Last Name*
Sixth Parent Date of Birth*
Seventh Parent Name

First Name*

Last Name*
Seventh Parent Date of Birth*
Eighth Parent Name

First Name*

Last Name*
Eighth Parent Date of Birth*
Ninth Parent Name

First Name*

Last Name*
Ninth Parent Date of Birth*
Tenth Parent Name

First Name*

Last Name*
Tenth Parent Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive gym closures and information by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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