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TRANSCRIPT
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ATHLETE INFORMATION
State: Zip:
DOB:
3$5(17�*8$5',$1 INFORMATION�
Parent/Guardian 1: Cell Phone #: Email: Parent/Guardian 2: Cell Phone #: Email:
MEDICAL INFORMATION
Please list any physical/psychological limitations, KHDOWK�FRQGLWLRQV� injuries, or weakness that may affect the athlete’s participation and/or performance:
Allergies:Medications (list all):
Insurance Carrier: Policy #�3DUHQW�Social Security #� Emergency Contact #:
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Notary Seal:
AthOHWH�1DPH (Print)�
Athlete Signature:
Date:
Parent/Guardian Name (Print):
Parent/Guardian Signature:
Date:
1RWDU\�RU�:LWQHVV (Print):1RWDU\�RU�:LWQHVV�6LJQDWXUH: Date:
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Name: Address: City: Gender:
Cell Phone #: Email:
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Social Media Handles (FB, IG, Twitter - Please list all that apply):
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Ch
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p.1
Are you interested in being a cross-teamer? If so, list the level(s) you are interested in�
T/Tank ________
S Bra ________
Shorts ________
V-Ro ________
Uniform Top ________ +/- ________
Uniform Mesh ________ +/- ________
Uniform Bottom ________ +/- ________
Warm-up Jacket ________ +/- ________
Warm-up Pants ________ +/- ________2
Please put a check mark ,1�7+(�&,5&/(6�21/< for skills you can currently complete safely, consistently, with good technique, and :,7+287�$�63277(5.
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Coach 2
(SWDII�RQO\�EHORZ�OLQH)D1 Comments: D2 Comments:
Stunt Position:
Beginner Forward Roll
Backward Roll
Cartwheel
Round Off
Team/Level:
Coach 1
Ch
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lete
Eva
lua
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Fo
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p.2
Standing BHS
Jumps pause BHS
Round Off BHS
Front Handspring
Standing 2 BHS
Jumps to BHS
RO BHS Tuck
Standing Tuck
Standing BHS Tuck
Jump to BHS Tuck
RO BHS Layout
Intermediate Jumps to Forward Roll
Jumps to Backward Roll
Bridge Kick Over
Back Walkover
BHS pause BHS
BWO BHS
RO BHS Series
Front Bounder
3 Jumps to BHS Tuck
3 Jumps pause Tuck
FWO RO BHS Layout
FWO RO BHS Series
Specialty Series
Front Bounder Step Out
FHS Front Bounder
Standing 3 BHS
3 Jumps to 2 BHS
FWO RO BHS Tuck
Punch Front
Jump BHS Jump BHS
Jump BHS Step Out RO BHS Tuck
FWO RO BHS Step Out RO BHS Tuck
Punch Front Pause RO BHS Tuck
Punch Front RO BHS Layout
RO Whip BHS Layout
RO Whip Punch Layout
Jump to Standing Full
BHS Series to Double Full
Standing Specialty to Double Full
Running Specialty to Double Full
LEV
EL 1
O
O
O
O
O
O
O
LEV
EL 2
LE
VEL
3
LEV
EL 4
LE
VEL
6-7
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
RO TuckO
Standing BHS Full
Standing Full
Arabian to Full
RO BHS Double Full
O
O
O
O
O
Advanced Front Walkover
Back Walkover Series
Specialty Series
3
Please circle the two evaluation dates you will attend:
May 7 8 12 13 14 15 16
Jumps to Tuck
RO BHS Full
FWO RO BHS Full
Standing BHS Layout
RO Whip 2 BHS Full
Jumps to BHS Layout
BHS Whip BHS Layout
O
O
O
O
O
O
O
O
O
O
O
3 BHS Full
2 BHS Full
Jump 2 BHS Full
CW Full
PK ______ FH ______ TT ______ 3 Jumps ______ PK ______ FH ______ TT ______ 3 Jumps ______
Stunt Position: Team/Level:
LEV
EL 5
Athlete Name Age
TEAM MEMBER PACKET *All deposits are due by the Mandatory Parent Meeting.
! TINY LEVEL 1 ATHLETES (6 & Under) “Squirts”Non-refundable deposit + monthly payments of
$400.00 (divided into 3 payments) $110.00
Deposit includes: annual gym registration, 2 practice uniforms, competition uniform rental fee, competition routine choreography and music.
Monthly payments include: monthly tuition for team training and 2 competition registration fees.
Note: Makeup, bows, warm-up suit, sneakers, personalized backpack, and team T-shirt are billed separately. However, the only items that are mandatory are the showcase fees, bows, sneakers, and team T-shirt. “Squirts” usually attend 1-2 showcases/performances.
! FEMALE CHEER ATHLETESNon-refundable deposit Level 1 & 2 +11 monthly payments of Level 3 - 6 +11 monthly payments of
! MALE CHEER ATHLETESNon-refundable deposit + 11 monthly payments of
New Member: $500.00 $305.00 $325.00
$500.00 $275.00$305.00
New Member: $300.00 $188.00
Returning Member:
Returning Member: $300.00 $168.00
Scholarship programs may be available for boys ages 14-18 that can work in the summer.
Deposit includes: annual gym registration, team summer camp training, 2 full practice uniforms, competition routine choreography and music.
Monthly payments include: monthly tuition for team training, 1 competition uniform, 1 competition bow, 1 makeup kit, 1 pair of practice sneakers, 1 pair of competition sneakers, 1 personalized warm-up suit, 1 personalized backpack, all national competition registration fees, and all coaches’ travel expenses. Note: Travel/lodging and local/regional competitions are NOT included. All vacation/holidays are already prorated into the monthly fees.
! OPEN TEAM ATHLETES (Adult Teams)For financial commitments and practice schedules, please refer to our separate paperwork for Open Team athletes.
11
1
4
RULES AND REGULATIONS CONTRACT
I have read the Top Gun Rules and Regulations Contract available on the Top Gun website in its entirety and understand its contents. I understand the responsibility my child is undertaking by becoming a Top Gun member. I agree to fully support my child and will encourage them to fulfill their commitment. I also understand that by signing this contract I am bound to not use my child’s participation in this program as a form of punishment as I realize that it also punishes their team and the entire Top Gun program. Furthermore, I understand that being a Top Gun member is a commitment on the part of the parent as well. I realize that when representing Top Gun I must always conduct myself with class and responsibility. I understand that any athlete or parent that does not abide by the rules and regulations contained in this contract, that is consistently negative, or acts in a manner that jeopardizes the name and reputation of the Top Gun program, will be subject to removal with no refund. In addition, I agree to give Top Gun full permission to seek medical attention and/or take any actions deemed necessary including but not limited to drug testing to ensure the safety and well being of my child and those around them.
____________________________ ____________________________ _________ Athlete Name (Print) Athlete Signature Date
____________________________ ____________________________ _________ Parent Name (Print) Parent Signature Date
OFFICIAL NOTARY _________________________ DATE: ____________ SIGNATURE & SEAL
5
AUTO DEBIT AUTHORIZATION FORM
Every athlete MUST turn this form in with a voided check.
Athlete Name (Print): _______________________________________
Bank Information
Name of Bank/Financial Institution: ____________________________
Bank Routing #: ___________________________________________
Bank Account #: ___________________________________________
Name as it appears on the account: _____________________________
Address as it appears on the account:
________________________________________________
________________________________________________ (City, State, Zip)
Phone #: __________________________
Alternate #: __________________________
I have read and understand the financial policies of Top Gun Cheer and Dance Training Center, Inc. I am authorized to sign on the account listed above and I certify that all the information above is complete and accurate. I hereby authorize Top Gun Cheer and Dance Training Center, Inc. to collect payment for fees due by processing a debit to the account listed above on the first of each month. I understand that if the debit should be returned, a $25.00 returned item fee would be assessed.
Name (Print): ______________________________________
Signature: ______________________________________
For office use only:
Team: _________________
Debit: _________________
Special Instructions:
_________________________
6
PAYMENT OPTIONS AND INFORMATION
• Monthly Payments - All monthly payments are auto debited on the 1st of every month.
• Quarterly - All quarterly payments are due on the 1st of June, September, December, andMarch. Each quarterly payment is equal to the sum of 3 monthly payments with theexception of March (only 2 monthly payments).
Sibling Discount(s) - A $25.00 discount for all monthly payments will be applied to families with more than 1 child in the full All Star cheer program. There are no discounts on the deposit.