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ORIGAMI RHYTHMICS #109-1647 Broadway Street, Port Coquitlam, BC
Registration Form 2019-2020Gymnast Information
First & Last Name_____________________________________________________________Date_________________________
Address______________________________________________________________________________________________
City______________________________ Province________________________ Postal Code________________
Phone____________________________ Date of Birth_____________________ Source of Referral____________________
Level____________________________Group____________________________ Coach________________________
Email Address___________________________________________________________________________________
Parent/Guardian Information (if gymnast is less than 19 years of age)
First & Last Name___________________________________ Relationship to Participant___________________
Address____________________________________________________________________________________
Personal Phone#: ____________________________ Secondary Phone#______________________
Emergency Contact (if Parent or Guardian not available)
Name____________________________________________________ Relationship to Participant______________________
Address_____________________________________________________________________________________________
Phone # ____________________________
Credit Card Information
Name on Card_________________________________
Card Number_________________________________
MC_____ Visa_____
Expiration Date ____/_____/_____ CVV Number ____ (back of card)
I hereby authorize ORIGAMI RHYTHMICS (hereinafter called the “Club”) to debit/charge the above referenced account for any amount owed to the Club for goods and services provided. This authorization is to remain in force until the Club has received written notifications of termination in such time and in such manner as to afford the Club and/or the Bank(s), Credit Card Company (hereinafter called the “Institution”) a reasonable opportunity to act on it. If your Bank refuses to honor a withdrawal because there are insufficient fund in your account, or your credit card issuer refuses to honor the charge for any reason, you will be liable for the additional $25.00 reprocessing fee. In the event that the Club notifies the Institution that funds transferred were not entitled to the Club, I hereby authorize and direct the Institution to return said funds to the above referenced account. By signing below, you acknowledge receipt of a copy of this Agreement and agree to be bound by its terms. This Agreement is not valid unless signed by an authorized representative of Origami Rhythmics.
Name_________________________________________________________ Date_____________________
Authorized Representative_________________________________________ Date_____________________
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• All payments are due on the 1st of each month.• Any additional payments for special events and competitions will be sent out prior to each event with due dates.• Parents must submit either post dated cheques, e-transfers or cash payments to avoid credit card charges.• Any payments not made within 7 days from a due date will be charged on the credit card with additional 3% processing fee plus $25 late
fee.• To avoid extra charges parents must submit all payments on or before the 1st of each month.
Medical ConditionsPlease describe any medical conditions of your child that the club and coaches must be aware of: ____________________________________________________________________________________________________________
Policies
1. Feesa. An advance-scheduling fee of $_____ is necessary before any training sessions and evaluations are
performed. The fee is NON REFUNDABLE (with the exception of the FIRST FREE ClassAgreement) and is credited to the total cost of your program.
*Important to note that in the case the gymnast/parent/guardian decides not to continue after theFIRST FREE Class full refund will be given only within a 14 day period starting from the FIRSTFREE Class.b. The FIRST FREE Class fee will be deducted from the total monthly fee following this formula:
- Total cost of monthly training divided by total number of hours.c. The total monthly cost of the program is due upfront before any training will begin.d. Tuition fee will always run on the first of every month.e. Initial reminder notifications regarding team related charges (excluding regular tuition fee) will be
sent via email no less than 7 days in advance of a charge.f. The training programs that are provided are non transferable.g. *If a gymnast misses more than 2 consecutive weeks of classes without a valid reason, such as
due to sickness, or injury, they must re-register with the club.
2. Refundsa. Except as described in section 1a. above, all tuition payments are non-refundable ____(initials).
b. If at any time an individual is unable to complete a training program due to an injurysustained during actual training in a Origami Rhythmics session, the remaining sessions will be heldon account until the participant is able to complete his or her training.
3. Scheduled Training Classesa. Any participant failing to show for a scheduled training class will forfeit that session______
(initials required).b. Failure to cancel within 24 hours notice will result in forfeiture of that session______ (initials
required).c. Parents are expected to bring their child to a training session 10 minutes prior to the training
session to allow their child change and be ready for training on time.4. Termination of Contract
a. Origami Rhythmics reserves the right to terminate the Participation Agreement of any participantimmediately if he/she fails to comply with rules and regulations of Origami Rhythmics, if he/sheengages in other conduct that is detrimental to the health or safety of the coaches, other gymnasts, orif parent/guardian fails to pay program fees or other amounts that are due to Origami Rhythmics.Upon termination or cancellation of the participation agreement, the participant will remain liable forany other outstanding dues or other charges owed.
5. Permanent Medical Disability of Participanta. In the event that the participant is permanently unable to exercise due to a medically documented
condition, Origami Rhythmics will require a signed letter from the gymnasts physician detailing themedical reason for cancellation of the Agreement. Once certified, the Participation Agreement willbe terminated as of the date Origami Rhythmics receives valid documentation of permanentdisability. No retroactive medical refunds will be issued.
6. Notice of Consumer Rightsa. Origami Rhythmics is not bonded because it does not collect more than three months advance
payment or charge an initiation fee in excess of $_____.b. You are entitled to a copy of this Agreement. You have the right to cancel the Agreement within
three business days after receiving your copy. To cancel this Agreement you must give OrigamiRhythmics written notice of the cancellation.
c. In the event Origami Rhythmics is completely closed for one month or more due to fire, flood, orother event that is out of the control of Origami Rhythmics, Origami Rhythmics will at it’s option,either: 1) extend your program for a period equal to the period during which Origami Rhythmics isclosed, or 2) refund your program fees for that period. If Origami Rhythmics is completely closed,due to the fault of Origami Rhythmics you may receive a refund of your program fees.
7. Entire Agreementa. You acknowledge that, except for what is contained in this Agreement, Origami Rhythmics has not
made any promises, representation or warranties to you. Only a written instrument signed by both theparticipant and an authorized representative of Origami Rhythmics may amend this Agreement.
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