Registering for 2nd-3rd Grade Gaga

Child Information

Player's Name:
Nickname:
Grade:
Birth date:
School:
Home Address:
- Home Address:
- Address2:
- - City:
  - State:
  - Zip:
Phone:
Email:

Parent & Emergency Contact

Parent 1 Name:
Contact Numbers:
- Parent 1 Cell:
- Parent 1 Work Phone:
Parent 2 Name:
Contact Numbers:
- Parent 2 Cell:
- Parent 2 Work Phone:
Emergency contact (other than parent):
Emergency contact phone:
Physician name:
Physician phone:
Additional notes (allergies, concerns, etc.):

Billing & Payment Information

Billing Address
- Use above information for billing
Billing Name:
Billing Address
- Billing address:
- Billing address2:
- - Billing city:
  - Billing state:
  - Billing zip:

Credit Card Number:
- Credit Card Number:
- - Exp. Month:
  - Exp. Year:
  - CVV Code:

Health Information

Waiver of liability:
Waiver of Liability: I understand and fully recognize that my or my child’s participation in the sport of gaga at The Gaga Center, Inc. (TGC) carries a risk of physical injury. I, on behalf of myself and my child, agree that TGC, its agents, employees, sponsors and volunteers should not be liable to me or my child or our respective heirs or legal representatives for any injury or damage, however caused, resulting directly or indirectly from my or my child’s participation in any TGC activity program at any time. I hereby waive, and release and discharge, TGC and its agents, employees, sponsors and volunteers from, any and all actions, claims and demands, which I or my child may have in connection with any such injury or damage. In an emergency, TGC or its designees will attempt to reach me (as well as my emergency contact) as soon as possible, but I understand that TGC will use its best judgment should it not be possible to contact me. I permit any physician selected by TGC to secure proper treatment for my child. Furthermore, I understand that payment for all such medical or surgical services is solely my responsibility. Photo/Video Release: I consent to the use of photos and videos taken by TGC, its agents, or the media, of my children or me to be used for editorial or promotional uses and waive all rights, which may arise as a result. Cancellation Policy: For semester-length sessions, a prorated portion of fees will be returned if a cancellation is requested prior to the 3rd meeting of a session. In the event of a cancellation, a $25 registration fee will be applied. The Gaga Center reserves the right to cancel a session due to low enrollment.
Confirm Waiver
- By checking this box, I agree to the terms and conditions and waiver of liability.

Summary

Start Date:

Jan. 8, 2024

Session time:

Mondays at 3:45pm

Grades:

2-3

Price:

$680.00 (+tax)

17 sessions

A charge of $680.00 (+tax) will appear on your card statement from The Gaga Center, Inc.

2nd-3rd Grade Gaga

Class runs from 3:45-4:45pm. Session will start on January 8 and run through May 20 with no class on January 15, February 19 and March 18.

Child Information

Parent & Emergency Contact

Billing & Payment Information

Health Information

Summary

Start Date:

Session time:

Grades:

Price: