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Name of Center:

Child's Name:

Age:

Male / Female:

Birthday:

Parent's Name:

Mailing Address:

Town/City:

State/Province:

Postal/Zip Code:

Phone:

Additional Phone:

Email Address:

Confirm Email Address:

Health Disclosure:

Stretch-n-Grow is a physical fitness and exercise program. Your child will be exercising through age-appropriate cardiovascular and callisthenic exercises for approximately 30 minutes once a week. Classes consist of a warm-up, aerobic activity, floor exercises, cool down, and stretching. Please list and describe below any injuries, allergies, or health conditions, which might limit your child's participation or check the "none known" box if none. Thank you.

NONE KNOWN

Food Allergy Disclosure:

Photo Release:

Occasionally photographs or videos of various classes are used for local and national marketing purposes. If you do not want your child's photograph/ video used please check the appropriate box below. NOTE: Names are not disclosed without specific permission.

YES NO

Kits:

Dancing Stars Kit - Dance Bag, Leotard, Tights, Ballet Slippers

All Star Cheer Kit - Cheer Bag, T-Shirt, Shorts, Socks, and Bow

All Star Sports Kit - Athletic Bag, T-shirt, Shorts, Water Bottle

Invoice will be emailed once enrollment form is sent.

T-shirts:

Please select sizes: Select XS (2-4) S (5-8) M (10 - 12) L (14 - 16)

Shorts:

Please select sizes: Select XS (3-4) S (5-7) M (8-10) L (12 - 14)

Socks:

Please select sizes: Select XS (Y-8 -12) S (12 - 14) M (Ad 5 - 9)

Leotard:

Please select sizes: Select 2-4 4-6 6-8 8-10 10-12 12- 14

Tights:

Please select sizes: Select 2-4 4-6 6-8 8-10 10-12 12- 14

MAKE A PAYMENT

Policies:

Returned Checks - when you provide a check as payment, you authorize us to use information for the check to make an electronic fund transfer from your account, or to process payment as a check transaction. You authorize us to collect a fee of $40.00 (plus a bank fee charged to the merchant if allowed by your state law) through electronic fund transfer from your account if your payment is returned unpaid.

Fifth Weeks - Stretch-n-Grow's tuition is based on four-week months. During the months with five weeks, classes will not be held during the fifth week unless otherwise specified.

Attendance - Monthly payments are made to Stretch-n-Grow regardless of the child's attendance. If you are planning for your child to be away from school, please notify our office in advance, and tuition will be prorated for your convenience.

Withdrawal - To withdraw your child, you must call or email our office. If you fail to notify us directly, billing will continue to accrue for which you will be responsible. Your child will not be dropped for non-payments unless a parent contact has been made. Please be courteous and provide us with a two-week notice if you plane to remove your child from Stretch-n-Grow. You may do so by calling our office 601-268-9342 or email lmccarty@stretch-n-grow.com. Stretch-n-Grow reserves the right to withdraw your child if tuition is two or more months behind.

Dress - Children should be dressed for action! This attire includes loose fitting clothing and athletic shoes. Dresses and sandals will inhibit movement.

Payment to non harm agreement

Payment Terms: I hereby authorize Stretch-n-Grow to charge my account as indicated above in consideration for professional services rendered (i.e. fitness/ dance classes.) I understand that automatic payments will be drafted on the first day of each month. Bankdraft and Credit Card payments will be prorated if necessary during the first month with subsequent drafts on the first day of each month. I understand that a two-week written notice (via hand-written letter or email) is required to cancel monthly recurring payments. I understand that Stretch-n-Grow is a voluntary enrichment program. I will not hold Stretch-n-Grow responsible for accidents.

I Agree By checking this box, I acknowledge that I have read and agree to the above terms.