2009 SUMMER
                     REGISTRATION FORM
To enroll in classes, return the completed form below with your
session fee and the *registration fee

      PLEASE MAKE CHECKS PAYABLE TO CPAG
        (One form for each child-please duplicate)

Child’s Name                                                                         

DOB _______/_______/_______ Grade                               
                                                       2009-10 school  year

             Circle one-        Female        Male

Address                                                                                 

City                                                       Zip _____________

Phone (H)                                                                             
(Mom-Cell)                                                                           
(Dad-Cell)                                                                             
(Work)                                                                               
1st Choice
Class                                 Day _______ Time __________

2nd Choice
Class                                  Day _______ Time __________
                        Family Discount  is 10%
               Class price $ 175.00-$17.50 = $157.50
                                 $ 198.00-$19.80 = $178.20
_________________________________________
                 List Sibling’s Class Name/day/time above(Office Use)











I am the legal guardian of the above named child.  I understand
that I am required to sign a waiver of liability and have read and
agree to follow the policy statement of CPAG.

_____________________________________________
                      Parent/Guardian signature
                                                      _____/_____/_____         
                                                                  Date
Print Name _______________________     __________
Session Payment (# _____ Wks)  
 $                     .
Family Discount 10%  
 .
Sub-Total  
 .
Registration Fee-if applicable *  
 .
Total  
 $                     .
Waiv.
2b
                   CPAG POLICY STATEMENT
PAYMENT
* Session payment and registration form are due at time of enrollment
*  Payment can be made by check or cash.
*  Make checks payable to CPAG with phone number, child’s name,
class, day, & time written in memo area.
*  Return check fee is $30.00.
REFUNDS
*  There are no refunds after the 3rd week of class, except for medical reasons,
*  Registration fees are non-refundable.
DISCOUNTS
*  A family discount of 10% is given for 2 or more gymnastics
classes per week, same or different child.
MISSED CLASSES
*  Make-up classes are available. There are no deductions for missed classes
ARRIVAL
* Students arriving more than 10 min. late will not be permitted in class.
Please schedule a make-up at the front desk.
*  Children are not allowed outside the building without an adult.
ATTIRE
*  Girls-One piece leotard, no skirt. Hair in a ponytail, bare feet.
*  Boys-Athletic pants, long or short, t-shirt tucked into pants, bare
feet  No oversize clothing.
*  NO JEWELRY OF ANY KIND.
SAFETY
*  NO ONE is permitted on the gym floor or equipment unless accompanied
by an instructor.
*  No gymnastics in waiting areas.
*  Children need to wait quietly in their designated waiting areas.
Parents are responsible for their child's safety in these areas.
*  Chewing gum, Heelys, ball playing, glass containers & running
are not permitted in the building.
*  Proper  behavior is very important for the safety of your child.
Any student acting in an inappropriate manner will be asked to
leave the gym.  Continued misconduct will be cause for permanent
dismissal from the program.  NO REFUNDS WILL BE GIVEN.
                       
                     PARENT/GUARDIAN WAIVER FORM
I agree that my child, named on reverse, will be engaging in physical exercise involving
various sports, coordination events, and fitness training which could cause injury to
them.  I agree to waive any claims or rights that I might otherwise have to sue C.P.A.G.,
its employees, owners, officers, or agents for injuries that might occur as a result of
these activities.  C.P.A.G. will make no evaluation or recommendation whether your
child is physically fit for any exercise activity.  It is always advisable to consult a
physician prior to undertaking any physical exercise program.  If my child has any
physical condition that may impair their ability to engage in these activities, it is my
responsibility to obtain a physician's statement describing any limitations to participate
in the program.

X                                                                                                                                               
                                            Parent/Guardian signature
                                                                                Date _______/________/_________

                                     Publicity Release Form
                                Photographs & Videotaping  

Many exciting events are captured on film.  CPAG will be taking pictures of students to
display on our bulletin boards, newsletter and our web site.  Please check your
preference in displaying your child's photo.
I do ______ (or) I do not ______    give permission for my child’s picture to be used for
advertising or display on Central PA Academy of Gymnastics bulletin boards,
newsletter, and/or web site.
X                                                                                                                                           
                                              Parent/Guardian signature
                                                                                Date _______/________/_________