Powerhouse Athletics

ONLINE REGISTRATION

This is the registration form for regular monthly tumbling classes and/or monthly competitive/performance teams as well as specialty camps and shops. If you do not see the program you wish to sign up for listed at the bottom of the page, let us know! If you have questions about what forms to fill out based on what class or program you are signing up for, please call 244-3363 or e-mail: powerhouseathletics@hotmail.com

*Required fields are marked with an asterisk (*)

*FULL NAME OF PARTICIPANT: *ADDRESS (street, city, state, zip): *DATE OF BIRTH: GENDER:
Male
Female
*PARTICIPANT'S CURRENT AGE: SCHOOL ATTENDING: *PARENTS'/GUARDIANS' NAME(S): *HOME PHONE: CELL PHONE: *PARENT'S WORKPLACE & PHONE #: *EMERGENCY CONTACT NAME: *EMERGENCY CONTACT PHONE: E-MAIL ADDRESS (please provide): *Does participant suffer from any of the following: MIGRAINES; ASTHMA; FAINTING SPELLS; SPINAL ABNORMALITIES; SPECIAL NEEDS (mental or physical)? Please list if participant suffers from any of these: *Please describe any other conditions we should be aware of: *CURRENT MEDICATIONS: *DOES PARTICIPANT HAVE MEDICAL COVERAGE?
YES
NO
IF YES, PLEASE PROVIDE NAME OF COMPANY AND POLICY NUMBER:

LOOK OVER THE FOLLOWING PROGRAMS AND PLEASE PUT IN THE APPROPRIATE LETTER FOR THE CLASS(ES) AND/OR PROGRAM(S) YOU ARE SIGNING UP FOR. *Please note that you must pay a $20 nr deposit to reserve your spot (you can mail it in or bring it into the gym.

A. TUMBLING (basic, intermediate or advanced) (once per week for one hour, runs non-stop - contact us for levels and practice times)

B. COMPETITION CHEER TEAM (any level) (runs non-stop - contact us for levels and practice times) *call for details

C. COMPETITION DANCE TEAM (any level) (runs non-stop - contact us for levels and practice times) *call for details

D. RECREATIONAL CHEER TEAM (regular or performance) (practices begin the end of September and will be on Thursdays

CHEER TEAM: 5-6pm CHEER/PERFORMANCE TEAM: 5-6:30m

E. FLIPPIN FUN TUMBLING CAMP In addition to letter "E", please state whether you are signing up for:

CARTWHEEL/ROUNDOFF CAMP - June 11, 18 & 25 from 9am - 10:30am

WALKOVER CAMP - June 11, 18 & 25 from 11am - 12:30pm or

BACK HANDSPRING CAMP - June 11, 18 & 25 from 1pm - 2:30pm

F. RED FEATHERS PERFORMANCE DANCE TEAM (5 consecutive weeks) - Sept. 3, 10, 17, 24 & Oct. 1 from 7-8:30pm

G. PAINT AND PLAY SUMMER CAMP (3 consecutive weeks) - July 16, 23 & 30 from 10am - 12 noon

H. CHEER TECH CAMP (2 consecutive weeks) - June 23 & 30 from 10am - 12 noon

I. CLOWN CAMP (1 day) DATES: June 10 from 10am - 12pm

J. TODDLER TUMBLE CAMP (3 consecutive weeks) DATES: June 12, 19 & 26 from 10am - 11:00am

K. LIL' MONSTERS DANCE CAMP (2 consecutive weeks) DATES: October 22 & 29 from 6:00pm - 8pm

*PLEASE ENTER THE APPROPRIATE LETTER (and additional information if necessary) FOR PROGRAM/CAMP YOU ARE REQUESTING: _________________________________________________________________________________________________________________________________________ I understand that should my child participate in a Powerhouse Athletics program or on a PA team, he or she will engage in a strenuous physical activity and there is a chance of injury or even death. Powerhouse Athletics activities include, but are not limited to, stunting, jumping, tumbling, playing, stretching, running, mounting, dancing, cheering and a variety of other physical activities. I understand the risks and give full permission for the above-mentioned child to participate in said activities and will not hold Powerhouse Athletics, its' owners, coaches or staff liable for accidents incurred during any of the above-mentioned activities. These activities can be performed inside the Powerhouse Athletics official facility and/or in other locations, including, but not limited to, parades, competitions and vehicles in transit to or from official PA activities. I also understand that in the case of an accident my personal insurance will be used to cover medical expenses for my child. *By typing your name here, you understand thoroughly the risks involved with joining Powerhouse Athletics. (Parent/guardian must type in your complete name): *TODAY'S DATE:

YOU MUST PRESS THE SUBMIT BUTTON. PLEASE ONLY PRESS IT ONCE TO AVOID MULTIPLE SUBMISSIONS. YOU WILL BE NOTIFIED SHORTLY ABOUT YOUR REGISTRATION AND CLASS/PROGRAM AVAILABILITY.

THERE IS A $25 REGISTRATION FEE THAT COVERS PROCESSING AND INSURANCE FEES. REGISTRATION FEE WILL BE DUE BEFORE REGISTRATION CAN BE COMPLETED. YOU MAY MAIL IT TO OUR FACILITY OR BRING IT IN IN WITH YOU.

Where Athletes Train.

ONLINE REGISTRATION