| REGISTRATION FORM |
| SALTO Gymnastics, Dance & Tiny Tot Fitness |
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Session 1 |
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Session 2 |
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Session 3 |
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| Student's Name___________________________
Birthdate___________ Age______
Phone_________________
Address_________________________________________
City______________________
Zip_____________
Emergency Contact________________________________
Emergency
Phone____________________________
Email Address (optional)____________________________
Class Level_________________________________
Day_____________________
Time___________________
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| A $20.00 NON-REFUNDABLE DEPOSIT MUST ACCOMPANY THIS REGISTRATION FOR
EACH CLASS THE GYMNAST IS REGISTERING FOR. BALANCE DUE BEFORE CLASS
STARTS. My child (or I) has (have) no physical, mental or emotional
problems that would interfere with participation in this program. I have
fully read and understand the
Registration and Payment Procedure and have signed the
Release and Acknowledgement of Risk Form. |
ANNUAL REGISTRATION FEE-All
students
are
required to pay a $20.00 Annual Registration Fee
per gymnast, or
$35.00 per family
that must be paid once
each year. For example, if the annual registration fee is first paid in
January, it need not be paid again until the following January, etc. Please
include this fee with your payment for all NEW STUDENTS and any CURRENT
STUDENTS whose anniversary month has arrived. This will occur in January,
June and September depending on which semester you first register in. |
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Signature______________________
(Parent or Guardian) |
Date__________ |
Class Fee______________________
Annual Registration Fee____________
Total Due_______________________
Deposit________________________Balance________________________
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| Print Parents Name
____________________________ |
Make Checks Payable To:
SALTO, INC.
| 1417 Poplar Dr. |
21950 Doral Rd. |
| Waukesha, WI 53188 |
Waukesha, WI 53186 |
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Master Card & Visa Accepted |
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| ****Please read and sign the
participant agreement and return with this
form**** |
