The Fear Management Summer Camp Workshop

1

Tumbler's Name* This field is required.

First Name

Last Name

2

Tumbler's age* This field is required.

3

What does your tumbler us their tumbling for?* This field is required.Select all that apply

School Cheer

All-Star Cheer

Gymnastics

Dance or Pom

Recreational

4

Will this be the tumblers 1st time working with me in person?* This field is required.

YESNO

5

What best describes what your tumbler is struggling with right now?* This field is required.

Mental block (extreme, paralyzing fear on a skill they use to have by themselves)

General confidence (lacking confidence in general as a tumbler, but not the extreme of a mental block)

Bad habits (poor technique overall that’s holding back from progressing)

Hit a plateau (not really dealing with fear, but just not progressing in their tumbling)

Other

6

Explain why you chose the above answer* This field is required.

7

About how long has your tumbler been dealing with this specific tumbling issue?* This field is required.

8

What tumbling skill(s) are most important to work on during our time together* This field is required.

10

Parent's Name* This field is required.Parent that will be traveling with tumbler

First Name

Last Name

11

Parent's Email Address* This field is required.

example@example.com

12

Parent's Contact Number* This field is required.

Please enter a valid phone number.

13

How did you hear about me?* This field is required.Ex: TikTok, Facebook, instagram, etc.

14

Where are you traveling in from?* This field is required.State and City

15

Assumption of Risk - Parent's signature required* This field is required.I, the minor's parent and/or legal guardian, understand the nature of tumbling and the minor's experience and capabilities and believe the minor to be qualified to participate in such activity. I fully understand that tumbling involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or in-actions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the minor named on this digital registration form under "Tumbler's name"; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of participation in tumbling.

16

Release of liability - Parent's signature required* This field is required.I do hereby release, protect, indemnify and hold harmless, Coach Levi Nickson, Tumble Smart Athletics LTD. CO. , it's employees, board members and volunteers, from and against all claims, liabilities, suits, actions, or proceedings which may arise out of, or in any way be connected with, any illness, injury or even death occurring during on-site or off-site tumbling. This indemnity shall include, but shall not be limited to, indemnification with respect to any costs of defense and attorney fees.

17

Photo/Video Release - Parent's signature required* This field is required.I hereby give Coach Levi Nickson and Tumble Smart Athletics LTD. CO. permission to use photographs and video recordings of my child for all purposes, including advertising, training and social media posts.

18

Refund Policy - Parent's signature required* This field is required.If you’re tumbler is unable to be attend workshop for any reason (Includes but is not limited to: Inclement weather, family emergency, injury, etc.) the money you deposited will be credited towards another service with Coach Levi in the future. By signing this you understand and are fully aware that refunds in part or in full are not offered for any reason.

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The total investment in this workshop is $698

In order to complete this form and save your spot for workshop you must make a minimum deposit of $349. When you click "NEXT" it will take you to the payment options.

Looking for a discount? If you choose "Pay in full", you will receive a 10% discount bringing your total to $628.20.

Want an additional discount 10% off to bring your total down to $565.38? You have 2 options! (Offers below cannot be combined and coupon codes will only work with the "Pay in full" option)

1. Join my online community to receive a coupon code for an additional 10% off.

2. Got a group? A total of 4 or more tumblers qualify for a group discount. If so, contact me to claim your group coupon to be used for each member of your group to recieve an additional 10% off at checkout as they complete their own form.

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Payment Options* This field is required.Choose the amount you'd like to pay today.

My Bag

1

DepositDeposit to secure spot in Workshop. Additional $349 will be due first day of workshop.
$349.00+Edit
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Pay in fullPaying in full today gives you a 10% discount on total amount of workshop.
$628.20+Edit
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Payment Methods

Debit Or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.