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PORT CITY GYMNASTICS - Web Registration Form

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Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Who is your employer?
Contact #2
How can we contact you?
(Emails are kept confidential)
Who is your employer?
Student #1
(format=mm/dd/yyyy)
Additional Info

NOTE: All of our classes are year-round. Please be sure to include your child's START DATE above. Also, please remember that you need to complete a STOP CLASS FORM (found on our website) to remove your child and discontinue payment.

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Required Policies and Agreements
ASSUMPTION OF RISK, WAIVER OF LIABILITY As legal guardian of the listed named persons, I recognize that potentially severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, including but not limited to inflatables, gymnastics, tumbling, cheerleading, clinics, camps, private lessons, birthday parties, birthday party guests, bring-a-friend, flip n' fun bus, ninja-zone,, open gym, sleepovers, after school care and field trips. Being fully aware of these dangers, I voluntarily consent to the aforementioned persons participating in any and all programs at PORT CITY GYMNASTICS and/or PORT CITY KIDS' GROUP, INC. and/or its CONTRACTORS (hereinafter collectively referred to PCG) and I ACCEPT ALL RISKS associated with that participation. In consideration for allowing my child to use this facility, I, on my own behalf and on behalf of my child, and our respective heirs, administrators, executors, and successors, hereby COVENANT NOT TO SUE and FOREVER RELEASE, PCG, its officers, directors, shareholders, employees or other representatives, whether paid or volunteer, from all liability for any and all damages or injuries suffered by my child while under the instruction, supervision or control of PCG. I also understand that it is the parent's responsibility to warn the child about the dangers of gymnastics, fitness and injury. The parent should warn the child according to what the parent feels is appropriate. PCG will only warn the child thru Safety Messages and its teaching style and progressions. I also understand and give permission for photographs and videos of my child to be used in print or broadcast media as deemed appropriate for the promotion of PCG.

TUITION PAYMENT, ENROLLMENT AND BILLING INFORMATION I understand if my child is enrolled in a program that has reoccurring monthly tuition I am continuously enrolled in the program and I will be charged monthly tuition charges on my account until I submit a Class Stop request form. This document may be obtained from the PCG business office or downloaded from the website: www.portcitygymnastics.net. If I am stopping a class (with reoccurring monthly tuition) it must be done on or before the last day of the month. If I stop a class after the month begins I will not receive credits and/or refunds for the remaining classes in the current month. I understand that PCG does not give credit and/or refunds for, but not limited to, programs, class(es), clinics, camps, private lessons, birthday parties, birthday party guests, bring-a-friend, ninja zone, open gym, after school care and field trips, missed and/or cancelled due to holiday, vacation, illness, weather or any other reason. PCG does not issue refunds. All sales are final for any product and/or service purchased and/or provided by PCG. Contingent on availability, PCG may issue a Free Pass to an open gym for a missed class. If I should receive five classes during the month instead of four there will be no extra charge although it will be considered a makeup for classes missed while we are closed for holidays. During the course of a year this averages out nicely and is a far less confusing payment arrangement for everyone concerned. I am responsible for timely payments of my balances due on my PCG account.

PCG does not give credit and/or refunds for missed and/or cancelled activities due to holiday, vacation, illness, weather or any other reason.
PCG does not issue refunds.

I must complete a CLASS STOP form to discontinue my child's monthly enrollment. Forms are available on the PCG website or from the front desk.

PERMISSION FOR EMERGENCY MEDICAL TREATMENT/MEDICAL INSURANCE I confirm that my child is in good health and I have medical insurance on my child and will provide coverage while he/she is enrolled. I fully understand that PCG and staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release PCG and staff members to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by the PCG and staff to seek medical help including calling of an ambulance for said child should the PCG and staff deem this to be necessary. Additionally, I hereby agree to individually provide for all medical expenses, which may be incurred by my child as a result of any injury sustained while participating at PCG.

From the date of registration forward my entire account balance shall be DUE ON THE FIRST OF EACH MONTH. I acknowledge I will incur a $25 administrative late fee for any balance not paid on or before the 5th day of the month. I understand this only applies to programs that have recurring monthly tuition. Fees for other products and/or services shall be paid for at the time of purchase and/or registration.

PCG will initiate electronic payments for any balances due on my account on the 2nd of each month. Payments will be processed with the payment method/information I have provided and is kept on-file with PCG. If for any reason, my payment is not processed completely/declined, due to card error or other processing issues, I acknowledge I will incur a $25 administrative late fee if balance is not paid on or before the 5th day of the month. If provided, an e-mail notification will be sent any time a payment is processed. I acknowledge that this authorization will remain in effect until I notify PCG business office in writing that the authorization should be terminated. If for whatever reason, payments cannot be processed and my account balance remains overdue, I understand that my enrollment in classes will be cancelled. I will be responsible for all costs incurred for collection of any delinquent charges/payments applied to my account. All currently enrolled students will be charged an annual registration fee of $50 (per family) that will be posted to my account on the 1st day of the month of my registration anniversary date with PCG. I understand and give permission for photographs of my child to be used in print without name as deemed appropriate for the promotion of PCG. PCG reserves the right to modify the terms of this agreement with written notice.

PCG's programs are designed for monthly tuition drafting from an e-billing system. PCG will try to accommodate any "Split Fee" billing needs, but cannot guarantee that it will draft in the manner requested. Splitting fees or paying in alternating months with more than one card can generate billing mistakes. Should that occur PCG will make every attempt to remedy the situation.

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