Fort Bend Impact Online Registration

Registration

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Welcome to Fort Bend Impact! Please complete the following registration form and select the class you would like to attend.

* denotes required fields

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

New or Existing Account*

Contact #1

First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

T-Shirt Size

Enroll in Classes

Add Another Student

Required Policies and Agreements

Release of Liability

As the legal parent or guardian, I release and hold harmless, Fort Bend Impact, its owner Charles Gilbert and operators from any and all liability, claims, demands and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participants and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Fort Bend Impact, its owners and operators or in the route to or from any of said premises.

I've read the above and agree.

Medical Emergencies

I, the undersigned parent or guardian, do hereby grant permission for my child to participate in the activity of tumbling for Fort Bend Impact by Charles Gilbert. In order for my child to receive medical treatment in the event she/he sustains injury or illness during participation in this activity, I hereby authorize the tumbling coach or supervising adult to obtain medical treatment for my child for such injury or illness during the activity, and I hereby hold Fort Bend Impact by Charles Gilbert and representatives harmless in the exercise of authority. I understand this activity; which involves risk to the participant. I further acknowledge and understand due to the nature of this activity, which involves inversion and rotation of the body, there is a possibility my child may sustain physical illness or injury (minimal, serious or catastrophic), in the connection with his/her participation. I further acknowledge and understand my child is assuming the risk of such physical illness or injury by participation and I further release Fort Bend Impact and Charles Gilbert and representatives from any claims for personal illness or injury that my child may sustain during participation in this activity.

I've read the above and agree.

Photography Consent & Release Form

I, the undersigned, as a parent and or guardian of my athlete grant to Charles Gilbert dba Fort Bend Impact and his staff, without compensation (other than participation in the programs at Fort Bend Impact, which is acknowledged as sufficient consideration), the unrestricted right to use and publish photographs of me and photographs of my child for any purposes which Charles Gilbert considers promotional for Fort Bend Impact, or its successors, including without limitations, use in displays, publications, electronic reproductions, web sites, and other promotional materials and other mediums. In addition, I grant permission to copyright the same. I also release all claims relating to said photographers. This release will last the duration of enrollment at Fort Bend Impact.

I've read the above and agree.

Payment Policies

I, the undersigned, agree to have my ACH (Automatic Check Debit) from my savings/checking account or credit card on file charged each month for month tumbling and private lessons. You will have provided this information at the time of enrollment into the system. These accounts will be run on the 5th of each month. I understand that if my account is not paid in full by the 7th of each month than a $20 late fee will be assessed to the account until the balance is paid in full. I understand that I can change my billing information in my parent portal at any time, but understand I must keep my credit card information and ACH up to date at all times including expiration dates on credit cards. You will receive an email for payments or decline notice to the email address on file. If you ACH declines you will be notified and a $20 INF fee will be added to the account. We will attempt to run the credit card until the 7th of the month if declined to give you time to update information in the system if needed and if balance is still owed we have the right to run the credit card/ACH on file again on the 20th for payment of entire balance.

I've read the above and agree.

Drop Policy

In order to be dropped from any class you must notify us through the parent portal by email. You must select from the top drop down list, drop class. The email will be sent directly to the FBI accounts department, which will in return send you an email stating that the request to drop a class has been received. I understand that monthly charges will continually be applied to my account until the email has been received by the FBI accounts. You must drop the class by the 4th of the month to not incur the monthly charges for that month. If you attend any classes during that month prior to the 4th and are dropping you will be charged for the entire month. All balances will be the will be the responsibility of the account holder. I, the undersigned, do understand this policy.

I've read the above and agree.

Registration Fee Policy

The registration fee is posted each January and that covers you from January to January, only if you continue classes consistently through the year. If you choose to not attend summer classes or drop a school year class you will be required to re-register and will have to pay the $30 per student registration fee to re-enroll in classes. If you register in November and December for classes the next January registration fee will be waived.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number