Ultimate Performance Gymnastics and Cheer Online Registration

Registration

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Welcome to Ultimate Performance Gymnastics and Cheer! Please complete the following registration form.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Health Insurance Carrier & policy number*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Contact #2

Contact #2 First Name*

Last Name*

How can we contact you?

Home Phone *

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class.

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class.

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class.

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Disabilites*

Special Needs*

Allergies*

Medications*

Please click on the Search button below, then choose the class.

Enroll in Classes

Add Another Student

Required Policies and Agreements

Assumption of Risk

SPORTS PARTICIPATION CAN BE DANGEROUS. I recognize that participation in all activities offered at Ultimate Performance Gymnastics LLC, d/b/a Ultimate Performance Gymnastics & Cheer, at 4289 124th Street, Chippewa Falls, WI, owned by MCW Properties LLC, such as gymnastics, tumbling, trampoline, stunting, dancing, cheerleading, physical fitness type activities, Nerf Wars, Ninja Warrior Challenge and Superhero Challenge activities can result in minor and severe injuries, permanent paralysis, brain damage, or even death.

I've read the above and agree.

Release of Liability

ON BEHALF OF MYSELF AND MY CHILD(REN), I ACCEPT ALL SUCH RISKS AND PROMISE NOT TO SUE, AND FOREVER RELEASE, Ultimate Performance Gymnastics LLC, d/b/a Ultimate Performance Gymnastics & Cheer, at 4289 124th Street, Chippewa Falls, WI, owned by MCW Properties LLC, each of their respective owners, members, directors, shareholders, employees, contractors, invitees, licensees and agents ("you") from all liability for damages or injuries incurred as a result of participation by my child(ren) or myself. This includes those injuries resulting from acts of negligence by you. I also waive all rights any third party may otherwise have to pursue claims against you on my behalf (including the right of subrogation). If, despite this agreement, I, or any third party on my behalf, makes a claim against you, I will defend, hold harmless and reimburse you for such claim and liabilities incurred as a result of such claim.

I've read the above and agree.

Photo Release

I am aware that photos and videos are taken from time to time for marketing (ie. Facebook , website, brochure use, newspaper, etc.) and instructional purposes and I hereby consent to their use by Ultimate Performance Gymnastics and Cheer and their agents.

I've read the above and agree.

Payment Policies

Payment will be charged within 3 business days of registration, on the credit card provided. Registration during the school year session will include first and last month's tuition as well as the annual registration fee. May tuition is non-refundable. ACH (Auto-debit from a checking or savings account) form is required for remaining payments. The ACH must be filled out no later than the 2nd week of class and is available in the office, or requested via email.
Payment for summer session will be payment in full.
If payment is declined for any reason, customer is responsible for any fees charged to UPGC due to the decline. In case of chargeback, all fees for services rendered must be repaid to UPGC. Without payment in full, child cannot continue/enroll for future classes. We reserve the right to submit any unpaid fees to small claims court.

I've read the above and agree.

Medical Emergencies

In the event of an accident or emergency I AUTHORIZE MY CHILD(REN) TO BE TRANSPORTED TO A MEDICAL FACILITY FOR TREATMENT, at my cost, and will hold you harmless in your management of such accident or emergency. I agree to provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury while on your premises or while under your care

If at any time during your child's enrollment with UPGC said child becomes injured (on UPGC site or off), UPGC must have a doctor's note releasing enrolled child to full activity before they are allowed to return to class. If there is an injury regarding any time out of class, a signed doctor's note must be submitted to the office and a meeting set up regarding future tuition payments.

I've read the above and agree.

Class Policies

* The $35 Annual Registration Fee is non-refundable. Please be aware of this when you register for a class. The Annual Fee is valid from September 1st of one year to August 31st of the following year.
*Summer session will be a prorated non-refundable registration fee.
*There is a $25 change class/cancellation fee after the first day of class.
* There is a $30 returned check fee/returned ACH. Each attempt to retrieve funds unsuccessfully will result in an additional $30 fee.
*Registration in a class after participation in a no-obligation trial class, the trial class will be charged as instructional time with remaining monthly tuition.
* Only one make-up class is allowed per participant, per month, provided there is class availability. Make-ups must be scheduled with the office and held within 2 weeks of the missed class. All make-ups must be completed within the current session or they are forfeited.
* Tuition is due within 3 business days of registration. Classes fill very quickly and payment secures a class spot for your child. The credit card on file will be charged within 3 business days of registration. If you wish to pay via another method, please contact the office via phone or email to make arrangements on the day of registration. This payment must be received no later than 3 business days of registration or your child may be placed on a waiting list and may lose their spot to a fully paid customer. May tuition is non-refundable.
* UPGC waiver must be signed and turned in and tuition needs to be paid before your child may participate in the 1st class. After the 1st week of non-payment, your child will be dropped from the class, unless otherwise notified.
* Our school year sessions are for 9 months. No refunds are issued after the first week of the month, regardless of participation. Our summer sessions are typically 10 weeks, dependent on the year.
* PARENT OBSERVATION: We have an Open Door Policy. Parents are welcome to sit in the viewing area and observe their athlete. Please observe without distracting your athlete, this includes coaching your child during the class. Athletes need to be allowed to learn in a pressure-free environment. If a parent continues to distract their athlete, they may be removed from the lobby.
* Children in the lobby must be attended by a parent or guardian. NO HORSEPLAY WILL BE TOLERATED in or out of the gym. Safety rules must be followed by all patrons on site.
* Drop off your class participant no more than 15 minutes prior to class. Pick up no more than 15 minutes after class. You may leave your child during class if your account information is up to date and they are in the Gym Gem levels. Preschool parents must remain on site.
*If your child is enrolled in our KinderGym or Super K classes, please have authorized adult on site during your child's class.
* In order to attend each session, your child must be registered and your account must be in good standing. You may not register for another class if there are outstanding bills on your account.
*You and Me Kid and 3 Year Old KinderGym must have an adult participating in the class with them. They must sign a waiver for themselves before participating and must stay off equipment. Only one participating adult per student, per class. Adult must be actively involved in class with the child. No cell phones in the gym. No shoes in the gym.

Attire for Girls:
* A form fitting one-piece leotard. Compression shorts are allowed. NO skirted leotards, they are a safety issue, and can get wrapped around the bar or the spotters arm, and can cause injury.
* Hair MUST be TIGHTLY SECURED and out of the athlete's face. The teacher will return the student to the parent to correct the hair if it is not secure. This is a SAFETY ISSUE! We sell ponytail holders for $0.25 in the office if you forget to bring one for class.
* Bare feet. * NO JEWELRY OR WATCHES. Small stud earrings are fine.

Attire for Boys:
* Elastic waist workout shorts. NO JEANS! Clothes must not have any buttons, zippers, or other items that might poke the participant or damage the equipment.
* A non-baggy t-shirt.
* Bare feet.
*NO JEWELRY OR WATCHES.
* Long hair MUST be TIGHTLY SECURED and out of the athlete's face. The teacher will return the student to the parent to correct the hair if it is not secure. This is a SAFETY ISSUE! We sell ponytail holders for $0.25 in the office if you forgot to bring one for class.

***IF CORRECT ATTIRE IS NOT WORN TO CLASS, PARTICIPANT MAY BE EXCUSED FROM CLASS WITHOUT REIMBURSEMENT.***

I've read the above and agree.

30 day notice of Departure

If you decide (for any reason) to drop your child's class, you are required to fill out and submit a 30-day notice of departure form in our office. This may also be requested via email. The notice must be in writing and be submitted 30 days prior to departure.
Any outstanding fees must be paid in full and tuition will be due during the 30 days prior to departure.
The 30 days will begin on the day the form is submitted in person, in our office.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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Payment Information

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Credit Card

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Exp Year *

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Address Line 1

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City

State

Zip*

eCheck/Bank Draft

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Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

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