OPEN GYM @ Skills on the Hill
Skills on the Hill is happy to open our gym to our community. The purpose of Open Gym is to give our community access to our equipment and provide a fun place to play while simultaneously building skills. While we will have a therapist present to suggest ways to play and assist in equipment set-up, family/caregivers must stay with their child at all times.There will be a cap of 10 children per session at Open Gym, and time slots are available by age and time.
Parent Name
*
First Name
Last Name
Child #1 Name
*
First Name
Last Name
Child #1 DOB
-
Month
-
Day
Year
Date
Child #2 Name
First Name
Last Name
Child #2 DOB
-
Month
-
Day
Year
Date
Child #3 Name
First Name
Last Name
Child #3 DOB
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Are you an active client of Skills on the Hill?
*
Yes
No
Are you interested in being added to our newsletter list?
*
Yes
No
How did you hear about us/OPEN GYM?
*
SOTH newsletter
Facebook Group
Instagram
LinkedIn
Other professional
Other
Flyer posted at SOTH office
SOTH web site
Friend
Agreement & Release of Liability
I understand that by signing, I accept full and complete risk and liability for any injury or harm that may occur while my child/renis playing on the equipment at Skills on the Hill, LLC. During Open Gym, I agree to closely monitor my child(ren)for safety purposes throughout the time I am in the facility. There are specific indications that make a child/ren an inappropriate fit to play at Open Gym. It is my obligation to inform Skills on the Hill of any change in my child’s (or childrens') health/medical status that I am aware of that might impact my child’s (or children's) safety or the safety of someone else while engaging in play at Open Gym.
Parent signature
*
Illness Policy
Please do not bring a sick child to Open Gym. No child or adult who presents with or who has experienced any of the following indicators in the last 24 hours will be permitted into the clinic: fever of 100.4°F or above, sore throat, diarrhea, vomiting, any rash that could be contagious, lice, severe cough different from baseline. If a family cancels their reservation for illness, a session will be credited back to them to use for a future date. If a family does not attend for any other reason, no credit will be given. The family pays for the whole session reservation, regardless of how much time they spend at the session.
Parent signature
*
Open Gym Costs - PLEASE NOTE A SESSION IS 60 MINUTES
*
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next
( X )
Drop-In - 1 child
$
30.00
Child
1
2
Drop-in - 2 children
$
55.00
Quantity
1
2
3
4
5
6
7
8
9
10
Drop-in 3 children
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Select OPEN GYM session(s) you are signing up for: PLEASE NOTE A SESSION IS 60 MINUTES
Monday: 10/13 VA Office - 9:00 am ALL AGES
Tuesday: 10/28 VA Office - 3:00 pm ALL AGES
Thursday: 10/30 DC Office - 3:00 pm ALL AGES
Payment Methods
Choose from one of the PayPal options to
make your payment.
Submit
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