*Your Last Name
*Your First Name:
*Child's Last Name
*Child's First Name:
*Child's Date Of Birth:
*Street Address:
*City:
*State:
*Zip Code:
*Home Telephone:
Cell Phone:
*Email

You are registering for the West University Location

Monday Class Choice Only

11:55-12:40 Preschool children

12:50-1:35 Pre-K children

Please Note:

I, the undersigned parent or guardian of the above student(s), hold the tumbling Company of Houston, its staff and the host organization harmless for any and all injuries my child may incur during the scheduled tumbling or dance activities.

If needed and in the event that I cannot be contacted, I herby authorize medical treatment for the above student(s).

I understand that I am enrolling my child for the 2005-06 class sessions and that I may withdraw my child at any time by providing written or verbal notice to Robbie Hirst. Upon request, I understand that a prorated refund will be remitted for classes paid for and remaining in the session. All refunds are subject to a $25 processing fee. I also understand that if I withdraw my child(ren) I will be liable for tuition payments of all scheduled classes up to and including the termination date.

I have read and agree to the above statements:
(registration will not be sent unless you check the above box. Please Contanct Coach Hirst for further details.)