Tiny Tumblers Winter GYM Registration Form
Registration for GYM at 146 S. Peaceful Court, Cedar City, UT 84720.
Email address *
Athlete Name (nickname)
Your answer
Athlete Age/Gender
Your answer
Guardian Name (first & last)
Your answer
Guardian Contact # (EX: 801-787-7510)
Your answer
2nd Contact # & Relation to Athlete
Your answer
Best Form of Contact
Prices: MONTHLY tuition payment incurs a $2/mo processing fee, OR pay by SEMESTER (from whenever you start... or 4 months- Aug. 19-Dec. 15th). *
Class Preference (In Order By Day of the Week) *
**Click all classes that apply to the athlete. FALL CLASSES START AUGUST 19-24, 2019** Class Size: (Preschool= 4-6 athletes for 2-4yr olds, 8-10 athletes for 4-5yr olds 1-2 coaches, ALL others classes= 10-12 athletes w/ 2 coaches)
$5 Referral Bonus. List the name of a friend that referred YOU!
Your answer
How did you hear about Tiny Tumblers Gym?! *
Your answer
Liability & Medical Disclaimer
I realize that the activity for which I/my athlete is engaging involves a certain amount of risk and hereby agree to assume all such risk of myself/my athlete while participating in such activity. I certify that I have PROOF OF MEDICAL COVERAGE for my athlete/self and will cover all medical bills in the event of any injury, either while the coach is watching/spotting, or while attempting skills solo. I agree to release and indemnify Tiny Tumblers Gym, Kari Louthan, or any other agents and employees from any and all such claims due to loss, damage, or injury sustained by me/my athlete at the 146 S. Peaceful Court premises.

I understand that pictures and/or videos may be publicly posted of me/my child for marketing purposes of Tiny Tumblers Gym, unless written notification is made to withhold pictures/videos. Additionally, I will provide Tiny Tumblers Gym email written notification ONE MONTH PRIOR TO TERMINATION OF SERVICES, or will agree to pay one month’s tuition for failure to notify in advance. I understand that by choosing YES below, I am legally bound to the terms and conditions set in this liability and medical disclaimer.
Liability & Medical Disclaimer *
Payment Method (SEMESTER TUITION PREFERRED, or Monthly payments by the 20th of each month, for future services). *
Provide PROOF of Medical Coverage: HealthCare Provider Name ($20 non-refundable charge/semester for NONE) Pic Proof Required. *
Your answer
HealthCare Provider Plan#(or Member/Group ID) *
Your answer
Full Birthdate (Ex: 08/21/11) *
Your answer
Registration Reminders
*Please wear tight, but flexible attire. Please have hair pulled up & out of face, and always bring a LABELED water bottle. Have athlete run into the cul-de-sac and reserve driving into the cul-de-sac only for athlete pick-up by our large rock in front of driveway. Please park perpendicular to the cul-de-sac curbing, (which is straight into the cul-de-sac,) as there is limited parking space (2 spots only), and to AVOID blocking house on the RIGHT SIDE as you enter the cul-de-sac & ALL other neighbors driveways.

*Entrance is located at the door to the RIGHT side of the garage door. Please remove shoes and jackets on the hooks provided along the wall path. Please enter the premises, and head directly down the spiral staircase to the GYM facility. Arrive to class 5 minutes EARLY to allow for shoe/jacket/snow removal time.

*All cash financials will be communicated in an email form via: mytinytumblersgym@gmail.com. We have 4 seats available for viewing purposes, and you are welcome to watch your athlete when you choose, but are not expected to stay. We no longer do an organized parent watch day.

*We require a 1-month written notice of cancellation or customer agrees to pay for that month of tuition.*
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