FAME CLASS REGISTRATION FORM

CLASS__X___CAMP/CLINIC______FIELD TRIP______ BIRTHDAY______PRIVATE LESSON______

Class:__________________ Day/Time_____________________ Session:_________________________

Name ___________________________________________________ Age:____________ DOB:__________________

Address __________________________________________________ City, Zip__________________________________

Phone#_________________________________________ Email ______________________________________________
Please make checks payable to: FAME ALLSTARS INC. We also accept all major credit cards

Name on Card ________________________________ Card # ________________________________________

Exp ______Security Code_____Zip _____Amount $______Signature Of Cardholder _________________________
WEBSTER THOMAS HIGH SCHOOL ~ JV
MONDAYS 5:30-6:30 (8 weeks)
9/8, 9/15, 9/22, 9/29, 10/6, 10/13, 10/20, 10/27
$80.00 PER PERSON
Class Description: Tumbling will be structured within the levels (Beginner, Intermediate, and Advanced)
Synchronized tumbling; Standing and Running will be done every class
Specialty and corner passes every class
Strength training and conditioning every class
Please note that makeup sessions are not offered unless we have to cancel class due to extreme weather. Your personal reasons
for missing (vacations, sickness, etc) will not count for makeups or refunds.
Return check policy: A $30 fee will be charged for each check returned for insufficient funds.
Clothing: Please be sure your child is dressed appropriately for classes. Girls should wear tight fitting athletic shirts
and shorts. No jewelry may be worn and long hair should be tied back. Boys should wear athletic shirts and shorts. No
loose or baggy clothing please, as it may catch on equipment.
Missed Classes: We believe that allowing a student to participate in a class that he or she is not regularly enrolled
in is disruptive to the program. If a child would make up a class, he/she would most likely have different instructors. This
means that the instructor would not know the childs name or skill level. Student to teacher ratios are also disrupted by
allowing make-ups. For these reasons, we do not allow make-ups.

Inclimate Weather Policy: FAME NY ALLSTARS, INC. will make every reasonable attempt to open our
doors for business on regularly scheduled class/practice days. However, in the event of severe weather conditions,
notification will be posted on the FAME NY website, Facebook page, twitter and / or emailed.


FOR OFFICE USE ONLY:
PAID: $____________________CHECK:____________CC:_______________CASH:_______________


REGISTRATION AND EMERGENCY RELEASE FORM
(This form must be filled out completely-Please Print)
ATHLETE INFORMATION:
Athletes Name _______________________________________________Date of Birth ______________ Age as of 8/31/14 __________

Athletes Full Address ________________________________City_____________ State ______ Zip __________ ___________________

Athletes Home Phone # ____________________________ Athletes Cell #__________________________________________________

Name of School 2014-2015 _________________________GRADE ________Athletes E-mail_________________________________

PARENT/GUARDIAN INFORMATION:
MOTHERS INFO
Mothers Name _________________________________________________ Mothers E-mail ____________________________________ __

Mothers Full Address ______________________________________ City ______________________ State ______ Zip_______________

Mothers Home Phone # ____________________________ Work # ________________________Cell # ____________________________

FATHERS INFO
Fathers Name ____________________________________________________ Fathers E-mail ____________________________________

Fathers Full Address _____________________________________________ City __________ State __________ Zip________________

Fathers Home Phone # _____________________________Work # ________________________Cell # ____________________________

EMERGENCY CONTACT INFORMATION
Emergency Contact ______________________________________ Relationship to Athlete ____________________________________

Home Phone # ___________________________________ Work # __________________________ Cell # _____________________________

MEDICAL INFORMATION
Athletes Physician _____________________________________________________Phone # _____________________________________

Insurance Company ________________________________ Name of Subscriber ______________ Policy # _____________________

Allergies/Medical Conditions ___________________________________________________________________________________________
I allow my child to be given the following medication(s) if necessary, while at the gym _____Tylenol ____Advil ____Pepto Bismal

Medical Release and Liability Waiver

I, certify that ________________________________________ is physically capable and able to fulfill requirements needed to participate in all aspects of the FAME
ALLSTARS, INC. (hereinafter referred to as FAME) program and hereby give consent for him/her to participate in all aspects of FAMEs program. I Hereby release, discharge,
hold harmless, covenant to indemnify and not to sue FAME, its directors, officers, employees, coaches, volunteers, managers, agents, sponsors, shareholders, and any associated
personnel, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the participant as a result of
participation in FAMEs program(s) and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I
hereby authorize. This release includes any claims of negligence, and is intended to be as broad as is permissible under New York State Law.

Statement of Hazards of Participating in Athletic/Cheerleading/Tumbling

I, the undersigned participant and parent/legal guardian of the above listed minor (if participant is under the age of 18) acknowledge and fully understand that each participant will
be engaging in activities that involve serious risk of injury, including but not limited to, death, serious neck, head and spinal injuries which may result in complete or partial
paralysis; brain damage; serious injury to virtually all internal organs; muscular skeletal system; and serious injury or impairment to other aspects of the body , general health and
well being and any other unknown risks not reasonably foreseeable at this time. I assume all the foregoing risk and accept financial responsibility for the damages following any
such injury.

Medical Treatment Release

If a medical emergency should arise during my childs participation with FAME ALLSTARS, INC. (hereinafter referred to as FAME) at a time when I am not
personally present so as to be consulted regarding his/her care; I hereby authorize any agent of FAME, on my behalf to take whatever measures are necessary to
ensure that he/she is provided with any emergency medical treatment including hospitalization, which FAME deems advisable in order to protect his/her health and
well being and I agree to be financially responsible for the cost of such assistance and/or treatment

_____________________________________________________________________ _________________________________

Parent/Guardian Signature Date

_____________________________________________________________________ __________________________________

Cheerleader Signature Date

FAME CLASS REGISTRATION FORM
CLASS__X___CAMP/CLINIC______FIELD TRIP______ BIRTHDAY______PRIVATE LESSON______

Class:__________________ Day/Time_____________________ Session:_________________________

Name ___________________________________________________ Age:____________ DOB:__________________

Address __________________________________________________ City, Zip__________________________________

Phone#_________________________________________ Email ______________________________________________
Please make checks payable to: FAME ALLSTARS INC. We also accept all major credit cards

Name on Card ________________________________ Card # ________________________________________

Exp ______Security Code_____Zip _____Amount $______Signature Of Cardholder _________________________
WEBSTER THOMAS HIGH SCHOOL ~ VARSITY
WEDNESDAYS 7:00-8:00 (8 weeks)
9/3, 9/10, 9/17, 9/24, 10/8, 10/15, 10/22, 10/29
$80.00 PER PERSON
Class Description: Tumbling will be structured within the levels (Beginner, Intermediate, and Advanced)
Synchronized tumbling; Standing and Running will be done every class
Specialty and corner passes every class
Strength training and conditioning every class
Please note that makeup sessions are not offered unless we have to cancel class due to extreme weather. Your personal reasons
for missing (vacations, sickness, etc) will not count for makeups or refunds.
Return check policy: A $30 fee will be charged for each check returned for insufficient funds.
Clothing: Please be sure your child is dressed appropriately for classes. Girls should wear tight fitting athletic shirts
and shorts. No jewelry may be worn and long hair should be tied back. Boys should wear athletic shirts and shorts. No
loose or baggy clothing please, as it may catch on equipment.
Missed Classes: We believe that allowing a student to participate in a class that he or she is not regularly enrolled
in is disruptive to the program. If a child would make up a class, he/she would most likely have different instructors. This
means that the instructor would not know the childs name or skill level. Student to teacher ratios are also disrupted by
allowing make-ups. For these reasons, we do not allow make-ups.

Inclimate Weather Policy: FAME NY ALLSTARS, INC. will make every reasonable attempt to open our
doors for business on regularly scheduled class/practice days. However, in the event of severe weather conditions,
notification will be posted on the FAME NY website, Facebook page, twitter and / or emailed.


FOR OFFICE USE ONLY:
PAID: $____________________CHECK:____________CC:_______________CASH:_______________


REGISTRATION AND EMERGENCY RELEASE FORM
(This form must be filled out completely-Please Print)
ATHLETE INFORMATION:
Athletes Name _______________________________________________Date of Birth ______________ Age as of 8/31/14 __________

Athletes Full Address ________________________________City_____________ State ______ Zip __________ ___________________

Athletes Home Phone # ____________________________ Athletes Cell #__________________________________________________

Name of School 2014-2015 _________________________GRADE ________Athletes E-mail_________________________________

PARENT/GUARDIAN INFORMATION:
MOTHERS INFO
Mothers Name _________________________________________________ Mothers E-mail ____________________________________ __

Mothers Full Address ______________________________________ City ______________________ State ______ Zip_______________

Mothers Home Phone # ____________________________ Work # ________________________Cell # ____________________________

FATHERS INFO
Fathers Name ____________________________________________________ Fathers E-mail ____________________________________

Fathers Full Address _____________________________________________ City __________ State __________ Zip________________

Fathers Home Phone # _____________________________Work # ________________________Cell # ____________________________

EMERGENCY CONTACT INFORMATION
Emergency Contact ______________________________________ Relationship to Athlete ____________________________________

Home Phone # ___________________________________ Work # __________________________ Cell # _____________________________

MEDICAL INFORMATION
Athletes Physician _____________________________________________________Phone # _____________________________________

Insurance Company ________________________________ Name of Subscriber ______________ Policy # _____________________

Allergies/Medical Conditions ___________________________________________________________________________________________
I allow my child to be given the following medication(s) if necessary, while at the gym _____Tylenol ____Advil ____Pepto Bismal

Medical Release and Liability Waiver

I, certify that ________________________________________ is physically capable and able to fulfill requirements needed to participate in all aspects of the FAME
ALLSTARS, INC. (hereinafter referred to as FAME) program and hereby give consent for him/her to participate in all aspects of FAMEs program. I Hereby release, discharge,
hold harmless, covenant to indemnify and not to sue FAME, its directors, officers, employees, coaches, volunteers, managers, agents, sponsors, shareholders, and any associated
personnel, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the participant as a result of
participation in FAMEs program(s) and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I
hereby authorize. This release includes any claims of negligence, and is intended to be as broad as is permissible under New York State Law.

Statement of Hazards of Participating in Athletic/Cheerleading/Tumbling

I, the undersigned participant and parent/legal guardian of the above listed minor (if participant is under the age of 18) acknowledge and fully understand that each participant will
be engaging in activities that involve serious risk of injury, including but not limited to, death, serious neck, head and spinal injuries which may result in complete or partial
paralysis; brain damage; serious injury to virtually all internal organs; muscular skeletal system; and serious injury or impairment to other aspects of the body , general health and
well being and any other unknown risks not reasonably foreseeable at this time. I assume all the foregoing risk and accept financial responsibility for the damages following any
such injury.

Medical Treatment Release

If a medical emergency should arise during my childs participation with FAME ALLSTARS, INC. (hereinafter referred to as FAME) at a time when I am not
personally present so as to be consulted regarding his/her care; I hereby authorize any agent of FAME, on my behalf to take whatever measures are necessary to
ensure that he/she is provided with any emergency medical treatment including hospitalization, which FAME deems advisable in order to protect his/her health and
well being and I agree to be financially responsible for the cost of such assistance and/or treatment

_____________________________________________________________________ _________________________________

Parent/Guardian Signature Date

_____________________________________________________________________ __________________________________

Cheerleader Signature Date