Texas Xtreme Sports Registration Packet

XTREME
Texas Xtreme Sports
Athlete Information
Name
Address
City
State
Zip
Date of Birth

Month Day Year
Date
Sex
Age
School Attending
Grade
Mother's Name
Parent/Guardian Information
Phone Number
Email Address
example@example.com
Father's Name
Phone Number
Email Address
example@example.com
Emergency Contact Information
Name
Relationship
Phone Number
Only the individuals listed above are authorized to pick up my child or be contacted in case of emergency unless otherwise advised by a guardian.
Program your child will be participating in, check all that apply

Tumbling Cheerleading Dance Karate Summer Camp
List below the class you will be enrolling your child. If registering for a Summer Camp, please list here the week(s) your child will be attending.
Payment Policy
Please read and understand that tuition is due on the 1st of each month and will be late as of the 8th. Each family will receive an email to pay your monthly invoice. If you are wanting to pay with cash or checks please come by the office to do so before the 5th of the month. On the 6th of the month, all unpaid invoices will be resent with a $35.00 late fee added. A credit card is required to be placed on file for all students. No tuition will be prorated for missed classes.
If payment is not made by the 5th of the month there will be a $25.00 late fee added for each month tuition is late. NO EXCEPTIONS! Please Initial.
Please Inital
If payment is not made by the 5th of the month there will be a $25.00 late fee added for each month the tuition is late. NO EXCEPTIONS!
Please Initial
There is a 30 day notice required for all cancellations. Please be advised that just because you stop coming to classes that is not considered a cancellation.
Please Initial
All fees must be paid on time, if an athlete falls one month behind on their payments, they will be suspended from tumbling until the balance has been paid.
Credit Card Information
Card Number
Exp. date

Month Day Year
Date
CVC Number
Card holders name
Cardholders Billing Address
I, the undersigned, authorize Texas Xtreme Sports to charge the credit card listed above, in the case of delinquent or missing all star payments or monthly tuition plus any late fees.

have read and fully understand the terms and conditions of the Payment Policy
Parent Signature

Clear
Date

Month Day Year
Date
Texas Xtreme Sports Media Release
Please be advised that while at the gym your child may be photographed/videotaped during various gym activities. With your consent, the photograph or video may be reproduced and released for use in the media, for example newspapers, brochures, flyers, videos, our gym website and various social media platforms such as Facebook, Instagram, and Snapchat.

Please indicate your preference below:
Athlete Name
Athlete Name

My child's photograph/video MAY be reproduced and released for use in the media. My child's photograph/video MAY NOT be reproduced and released for use in the media and therefore will be not included in pictures/videos.
Parent Signature

Clear
Date

Month Day Year
Date
Texas Xtreme Sports Medical Release Waiver
Student's Name
What will the student be participating in?
Please Check all that Apply:

Cheerleading Dance Karate Tumbling Summer Camp
I/We the parents of the named student participate in cheerleading, tumbling, dance, karate, or other physical activities while a student at Texas Xtreme Sports. By granting permission for said student to participate at Texas Xtreme Sports, I/We assume full responsibility for said student's personal safety and release Texas Xtreme Sports and its employees from any and all liabilities that may arise due to any injury including death to said student's participation in any activity at Texas Xtreme Sports, or which Texas Xtreme Sports is participating at elsewhere.
Initial Here
I/We understand that there is personal risk involved in any physical activity that involves motion, height, or rotation and that these activities can result in serious injury, disability, and/or death.
Initial Here
I/We declare that this student has been seen by a registered physician and has been cleared to participate in all physical activities at Texas Xtreme Sports.

I/We have read this Medical Release Waiver and fully understand and execute its contents as stated above.
Initial Here
I certify that the above listed student is physically able to fulfill the requirements to be a student at Texas Xtreme Sports. I understand that this form legally releases all obligations and responsibilities for medical treatment of my son/daughter in event of illness or injury during any activity when either parent can not be reached. If there is any physical or medical reason why he/she should not participate fully, Texas Xtreme Sports requires a doctor's release. Furthermore, Texas Xtreme Sports is not liable for any injury incurred during physical activity.
Initial Here
Parent Signature

Clear
Date

Month Day Year
Date
Medical Treatment Permission Form
Medical Treatment Permission Form

In the case of an emergency occurring while my son/daughter is at Texas Xtreme Sports, in a class, at practice, or a competition. I grant permission to Texas Xtreme Sports and its employees to take whatever action is necessary. In the event that I can not be reached, I hereby authorize Texas Xtreme Sports and its employees to give consent for my child to receive medical treatment.
Initial Here
Parent Name
Cell Phone #1
Cell Phone #2
Home Address
City
State
Zip Code
Doctor
Phone Number
Insurance Company
Policy #
If you do not give us permission or authorization for consent for medical treatment, what procedures would you like us to follow?
Check any and all that apply

Heart Condition Diabetes Asthma Convulsions Disorder
Are your child's vaccination records up to date?

Yes No
Any Allergies to Food or other allergens?

Yes No
If yes, please list
Any Allergies to Medication?

Yes No
If yes, please list
Additional Medical Information we should know?
Parent Signature

Clear
Date

Month Day Year
Date
Should be Empty:

XTREME

Texas Xtreme Sports

Athlete Information

Parent/Guardian Information

Emergency Contact Information

Payment Policy

Credit Card Information

Texas Xtreme Sports Media Release

Texas Xtreme Sports Medical Release Waiver

Medical Treatment Permission Form