Private Lessons Registration

Please review and complete the form below to register for private lessons. Private Lesson Fees for a set of four lessons are as follows:

Member pricing: $110.00 per hour lesson x4 = $440.00 + HST = $497.20
Non-member pricing: $130.00 per hour lesson x4 = $520.00 +HST = $587.60

Before completing this form, please speak to your coach of contact the gym to ensure instructor availability. Your instructor will confirm the dates and times of the lessons which should be entered in the form below once they are known.

Athlete Information

Athlete's Name *

First

Last

Gender *

Male
Female

Date of Birth *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Have you already paid the Gymnastics Ontario Insurance Fee of $50.00 for this calendar year? (If you have already been registered in a gymnastics program with us this year, you can assume that the fee has been paid) *

Parent / Guardian Information

Parent / Guardian Name *

First

Last

Parent / Guardian Phone or Cell Phone *

Parent / Guardian Email *

Confirm Email

Preferred method of communication *

Phone
e-Mail

Coach and Lesson Times

If you have already arranged a coach and dates and times for lessons, pleased enter them below.

Name of coach to provide instruction:

Lesson #1

Date

Time

Please enter the agreed upon date and time for the first lesson.

Lesson #2

Date

Time

Please enter the agreed upon date and time for the second lesson.

Lesson #3

Date

Time

Please enter the agreed upon date and time for the third lesson.

Lesson #4

Date

Time

Please enter the agreed upon date and time for the fourth lesson.

Informed Consent Agreement

I, the undersigned, hereby agree to indemnify and save harmless The Tumble Tot Co. of Newmarket, their/its officers, instructors, coaches, employees, members and clubs against all claims, demands, damages, actions, suits or proceedings arising out of participation of myself/my child, named above, in any gymnastic activity.
I, the undersigned, hereby acknowledge that certain risk of injury are inherent to participation in hand on science, arts and physical fitness & gymnastics activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of others, or combination of both.
I, hereby warrant that my child is physically fit to participate and understand that the choice to participate brings with it the assumption of those risk and results which are part of these activities.
I agree to allow my child to receive basic first aid/medical care from instructors/coaches certified in first aid if necessary.
The Tumble Tot Company reserves the right to use photographs of members for promotional purposes. If you do not wish your child’s photograph to be taken please notify The Tumble Tot Company in writing.
Refund will not be given. A credit will be applied to a future program for medical reasons only if the request is made in writing and accompanied by a doctor’s note. There is a $30.00 admin fee for this service. A charge of $50.00 will be levied on all NSF cheques.
I declare having read and understand the above informed consent agreement in its entirety and hereby consent to participate acknowledging all the foregoing. I also certify that the information provided in this form is, to my knowledge true and complete.

Consent *

I agree to the above terms. Signature on hardcopy form will be required on the first day of the private lesson.

Phone

Private Lessons Registration

Athlete Information

Parent / Guardian Information

Coach and Lesson Times

Informed Consent Agreement

Office Hours (in person)

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