Enrollment
Form(860) 745-2408
Healthtrax of Enfield
P.O. Box 3500
3 Weymouth Road
Enfield, CT 06082
Enrollment
Form
(860) 745-2408
Healthtrax of Enfield
P.O. Box 3500
3 Weymouth Road
Enfield, CT 06082
I hereby enroll my child(ren) for classes described below. I agree to be responsible for payment of tuition for all classes reserved for enrollee up to the ending date of the semester enrolled. Monthly payments are due on the first of each month. Semester payments are due by the first day of class. A late fee will be applied to all payments received after the second class of each month. I understand that my child is automatically enrolled into later semesters until I give notice. I understand that there are no refunds for registration fees and tuition paid. In addition, there will be a $25.00 service charge for any returned checks.
I certify I possess and agree
to use of the following personal insurance to cover any medical emergency that
may arise.
Insurance Co. ____________________________________ Policy No.
________________________
RELEASE OF ALL CLAIMS
In consideration of the permission
granted to my child to enroll and participate as a student at New England School
of Gymnastics. I hereby release and hold harmless the New England School of
Gymnastics, Healthtrax, it’s employees, instructors, agents, directors, and officers for any
and all claims, demands, liability, harm, injury or damage which may result to
my child while enrolled as a student of this school, including all risks
connected therewith.
I fully understand that my child/ward assumes all the risks in connection with enrolling and participating in the activities of this school. I understand that any activity which involves motion, rotation, height or inversion may cause serious accidental injury.
I further certify that my child/ward has undergone a complete physical examination within the last ____ months and that my child/ward is not suffering form any physical condition or disease which might increase the child’s risk of injury or accident by participating in this school.
I have read this release and read all of
its terms.
Signed (Parent/Guardian)
_______________________________________ Date_______________
Student #1
___________________________________ Sex M F
Date of Birth ____________
Class 1st Choice: Title_______________________ Day__________
Time__________ Start Date___________
Class 2nd Choice: Title_______________________ Day__________
Time__________ Start Date___________
Student #2
___________________________________ Sex M F
Date of Birth ____________
Class 1st Choice: Title_______________________ Day__________
Time__________ Start Date___________
Class 2nd Choice: Title_______________________ Day__________
Time__________ Start Date___________
Parent/Guardian's
Name_____________________________________
Phone No_______________________
Email ____________________________________________
Address_______________________________________________________________________________
City _________________________________ State ____________ Zip Code ___________
Please send this form along with a check made payable to "Healthtrax" for class fees described on the schedule and registration fee of $30 for the first child and $50 for two children, to the address above. Credit card payment and Cash also acceptable if registration is made in person at Healthtrax of enfield.