Summer 2022 Class Registration Form – Summer At Brentwood Commons

Class Schedule
Parent and Me – Walking to age 3: Wed at 8 am, 40-minute class $95 per session
Tumble Bears – 3 year olds: Wed at 9 am, 40-minute class $105 per session
Tumble/Kinder Girls – Girls aged 4 to kindergarten: Tues at 5 pm or Wed at 10 am, 55-minute class $105 per session
Girls Flip One – Girls entering 1st grade and older: Wed at 5 pm or Thurs at 5 pm, 55-minute class $115 per session
Girls Flip Two – Girls entering 1st grade and older: Wed at 5 pm or Thurs at 5 pm, 55-minute class $115 per session
Girls Flip Three – Girls entering 1st grade and older: Thurs at 5 pm, 55-minute class $115 per session
Middle/High School – Girls Middle school and older: Thurs at 6 pm, 55-minute class $115 per session
Lil’ Ninja – Children aged 4 to kindergarten: Wed at 5 pm, 40-minute class $105 per session
Ninja – Children kindergarten and older: Wed at 6 pm, 40-minute class $110 per session

Classes by Invitation Only
Girls Hot Shots: Wed at 8:30 am or Wed at 4 pm, 75-minute class $156 per session
Girls Team Copper: Wed at 10 am or Thursday at 4 pm, 90-minute class $225 per session for both classes, $185 one class

Session Dates
Session One: June 21 to July 14
Session Two: July 18 to August 18 (no classes July 25-28)

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Action Kids Summer Registration Form 2022

Child's Information

Last Name

First Name

DOB(MM/DD/YY)mm/dd/yy

Preferred pronounpick one!

Best cell number for contact

Addressaddress

CityCity

StateState

ZipZip

Has your child attended classes at Action Kids before

YesNo

Are there any medical/social issues that would affect your child's participation in the program?

0 / 500

Parent Information

Best email for contactemail will be used for confirmation purposes and camp updates

Parent/Guardian #1your full name

Parent/Guardian #2your full name

Address same as above? If, no please complete below

YesNo

Address same as above? If, no please complete below

YesNo

Parent/Guardian 1 Addressyour full name

Parent/Guardian 2 Address (if different)your full name

City/State/Zipyour full name

Parent/Guardian 1 PhoneParent/Guardian 1 Address

Parent/Guardian 2 Phoneyour full name

Please add a second email to our account.

Waiver/Release

Waiver

I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group gymnastics and other physical exercise sessions, programs or activities conducted at Action Kids at Brentwood Commons, Inc. (hereafter “Action Kids”) may involve gymnastics, tumbling, fitness, trampoline, cheerleading, dance, ball sports, swimming and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by Action Kids, its representatives or its contractors (collectively, the “Activities”).

I, as the parent/guardian of the above-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY Action Kids, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise.

I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS.

In the event of accident or emergency, I hereby authorize Action Kids to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold Action Kids and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities.

I understand that my child or ward’s participation in the Activities at Action Kids may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that Action Kids retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use.

Confirmation

I, as the parent or guardian of the above-named Minor Participant, certify that I have carefully read the foregoing Liability Release Agreement and by my signature below, including any signature affixed in electronic format, consent to be bound by its terms. If I am not the parent or guardian of the below-named Minor Participant, by my signature below, I nevertheless agree to all of the terms and obligations in this Liability Release Agreement, as though I was the parent or guardian of the Minor Participant.

Electronic Signatureyour full name

Date

Class Information

Please sign me up for the following session(s)

Session

Summer Session One: June 21 to July 14Summer Session Two: July 18 to August 18 (No classes July 25-28)

Please sign me up for the following class.

Class choice

Parent and Me: Wed at 8 am (Walking to 3 y/o) Tumble Bears: Wed at 9 am (3 y/o)Tumble/Kinder Girls: Tues at 5 pm (girls 4 to kindergarten)Tumble/Kinder Girls: Wed at 10 am (girls 4 to kindergarten)Girls Flip One: Wed at 5 pm (girls entering 1st grade and older)Girls Flip One: Thurs at 5 pm (girls entering 1st grade and older)Girls Flip Two: Wed at 5 pm (girls entering 1st grade and older)Girls Flip Two: Thurs at 5 pm (girls entering 1st grade and older)Girls Flip Three: Thurs at 5 pm (girls entering 1st grade and older)Middle/High School: Thurs at 6 pm (girls Middle school and older)Lil' Ninja: Wed at 5 pm (children age 4 to kindergarten)Ninja: Wed at 6 pm (children kindergarten and older)

Class choiceThe following classes are participation by invitation only

Girls Hot Shots: Wed at 8:30 am (girls age 4-6)Girls Hot Shots: Wed at 4 pm (girls age 4-6)Girls Team Copper: Wed at 10 amGirls Team Copper: Thursday at 4 pm

Payment choices

I have a card on file, please charge my card in fullI will call with a credit card for payment. Please note, Action Kids will email a class confirmation and invoice once registration has been processed by the office. We will hold unpaid spaces for 24 hours (or until the next business day for registrations processed over the weekend).

Administrative Policies

Make up classes:
Make up classes are available, space permitting. We will run one make up each session for any classes that only have one class option.
Refunds
There are no refunds should you wish to withdraw from class. House credit is available if we receive withdrawal request via email to [email protected] at least 24 hours before the start of the session. No house credit will be available after the session begins.

Administrative Policies Acknowledgement

I acknowledge the the above administrative policies.

Electronic Signatureyour full name

Date

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