Private Lesson Registration

First Name *

Last Name *

Parent/Guardian Email *

Accept to receive important notifications by email.

Parent/Guardian Phone *

Parent/Guardian Work Phone

Street Address *

Apartment #

City *

State *

Zip *

Athlete's First Name *

Athlete's Last Name *

Athlete's Phone

Athlete's Grade *

Athlete's Birthday *

Athlete's Age *

Cheer Level *

What type of lessons are you registering for? *

Tumble

Flyer

Base

Conditioning

Any specific you would like to work on?

Select the instructor you would like to work with *

Coach Yasmin

Coach Pauline

Coach P

Coach Jean

I understand that the coach will reach out to me to arrange date & time *

Athlete's Medical Information *

Please list any physical/psychological limitations, allergies, health conditions, injuries, or weakness (These can include but are not limited to: Asthma, Frequent Nose Bleeds, ADHD, Autistic, etc.) that may affect the student’s participation and/or performance. Please also list any medications taken by athlete (if a schedule is required for administering medication please also list that). If not applicable, please type N/A:

Permission for Emergency Treatment

This form will enable you/your child to receive emergency treatment if taken to the hospital by medical personnel. By signing you are giving permission for you/your child to be treated in the event of an injury or illness requiring emergency care.

Yes, I allow my child to receive emergency treatment *

Acknowledgements

I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false statements may result in denial of application or revocation of my membership.

Yes, I certify that the information submitted in this application is true *

Non-Refundable *

I understand that all payments made out to Flamez Elite Inc., are non refundable.

Yes, I understand this payment is non-refundable *

Personal Liability

I hereby agree to release Flamez Elite its representatives, agents, servants and employees from liability for any injury to the above named person, resulting from any cause whatsoever occurring to above named person at any time while attending this activity, excepting only such injury or damage resulting from willful acts of such representatives, agents, servants and employees. I do voluntarily authorize Flamez Elite assistants and/or designees to administer and/or obtain routine or emergency diagnostic procedures, and/or routine or emergency medical treatment for the above named person arising from or on account of said procedures and/or treatment rendered in good faith and according to accepted medical standards. I agree to indemnify and hold harmless Flamez Elite and/or assistants and designees from any and all claims, demands, actions, rights of actions, and/or judgments by or on behalf of the above named person.

Yes, I agree to release Flamez Elite Inc. and its staff from all liability *

Athlete's Name for Registration Confirmation *

Please type the full name below to confirm registration of the athlete

Parent/Guardian's Name for Signature *

Please type your full name below to sign the form and agree to the terms.

Order products

Order Total (The sum of all the prices of all the items in the order, taxes and discounts included.)

Contact information

Shipping address

Billing address