Online
Permission Slip
   
Tumblebus Shop
Student's Name:
Nickname:
Birth date:
Age:
Child Care Facility:
Class Room:
Student Schedule at School (M - T - W - TH - FR):
AM or PM:
Naps:
2nd Student Name:
Nickname:
Birthdate:
Age:
Classroom:
Schedule at School ( M- T- W- TH - FR):
AM or PM
Naps:
Email Address:
Address:
City, State and Zip
What are your goals for him/her with this program?
Any Medical limitations/physical concerns?
List Food Allergies:

PARENT / GUARDIAN INFORMATION:
Mother/Guardian:
Home Phone:
Work Phone:
Cell Phone:
Father/Guardian:
Home Phone:
Work Phone:
Cell:
__________________________________________________________________________________________________________

Do you consent to ABC Tumblebus, Inc. using photographs or videos of your child involved in an ABC
Tumblebus activity for any of its advertising, news coverage or promotional material?

__________________________________________________________________________________________________

I am aware of the risks of possible physical injury resulting from participation in gymnastics and related activites which require my child's adherence to all rules and disciplines of ABC Tumblebus, and I am willing to asume those risks.  I agree to release ABC Tumblebus Inc., its directos, officers, and/or employees, and the daycare facility associated from liabilit yfor injuries sustained while participating in any ABC Tumblebus activity.
Parent/Guardian Name:
Date:
Email:

__________________________________________________________________________________________________

Please select the session plan you would like to enroll your child in.  Make sure to pay for your child on line if you are planning to do so.  See our Tumblebus shop for registration fees.

__________________________________________________________________________________________________
Fall/Spring Session 2009 - 2010:

__________________________________________________________________________________________________

I understand that I am committing to a 9 month program; and that Ican withdraw any time by notifying the ABC Tumblebus office, and that I will be responsible for payment in full of all classes attended up to notification of withdrawal.

I understand
Child 1 T-Shirt Size:
Child 2 T-Shirt Size

__________________________________________________________________________________________________

I understand that payment is due on the 10th of each month and that if payment is not received by the 15th of each month, my debit/credit card below will be charged on the 16th of each month. If card is declined, my child will not be able to return to Tumblebus until payment is made along with a late fee of $7.50

I understand