Permission Slip

*** All information must be filled out completely below by parent or legal guardian***

Student Information:


Parent Information:


West Valley Gymnastics School Permission Slip Release of Liability and Indemnification Agreement

I understand that my child will be participating in gymnastics activities at West Valley Gymnastics School, located at 1190 Dell Ave in Campbell, Ca. I am fully aware of and appreciate the risks, including catastrophic injury, paralysis and death, as well as other injuries, damages, and losses that may result from participation in gymnastics activities and events. On my own behalf, and on behalf of my representatives and heirs, I hereby voluntarily agree to release, hold harmless, and indemnify West Valley Gymnastics School, its officers, directors, agents and employees (hereinafter collectively, “West Valley”), from any and all claims for personal injury, property damage or wrongful death, and any damages resulting there from, that may arise out of, or in any way related to, my participation in activities involving West Valley and travel related to such participation. I understand that this release is intended to discharge in advance West Valley from and against any and all liability arising out of, or in any way related to, my participation in activities involving West Valley, and related travel, even though liability may arise from West Valley’s negligence, or other conduct by West Valley. I have read and understand the terms of this release of liability and indemnification agreement, and I agree to be bound by its terms.


I hereby grant permission to West Valley to photograph and publish the photographs of me/or my child on West Valley premises and its website and in related promotional brochures. I hereby waive all rights of privacy and/or compensation for me or my child, which I or he/she may have in connection with the use of my or her/his photograph or likeness, or any or all of them. I, for myself, my child and our respective heirs, administrators, successors asnd assigns hereby release West Valley from and against any and all claims, liabilities or damages arising out of, or in connection with, the use of my, or my child’s photograph or likeness, or any or all of them, by West Valley for its business promotion activities.


I hereby release WVGS’ staff to render temporary first aid to my child(ren) in the event of injury or illness, and if deemed necessary to seek medical help, including transportation to a healthcare facility, or the calling of an ambulance. I do hereby authorize any trained medical professionals to administer emergency treatment to my child should illness or injury occur in my absence.


i fully understand that West Valley Gymnastics staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the West Valley Gymnastics staff to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by the West Valley Staff to call our doctor to seek medical help, including transportation by a West Valley staff member, and or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the West Valley Gymnastics staff deem this to be necessary. I do hereby authorize any trained medical professionals to administer emergency medical treatment to my child should illness or accident occur in my absence.


As legal guardian, you hereby consent to the aforementioned person participating in the West Valley Gymnastics School programs. I recognize that participating in this sport may be a dangerous activity involving MANY RISKS OF INJURY. I understand the dangers and risks include, but are not limited to, death, serious neck or spinal injury, which may result in paralysis, brain damage, serious injury to all internal organs, injury to all bones, ligaments, muscles, tendons, and other aspects of my child’s body. I understand the dangers and risks of playing or practicing may result not only in serious injury, but in serious impairment of future ability for my child to earn a living, engage in business, and generally enjoy life. I understand that it is the express intent of West Valley Gymnastics School to provide for the safety and protection of my child, and in consideration for allowing my child to participate, I hereby assume all the risks associated with the sport (of gymnastics) and agree to hold West Valley Gymnastics School, its officers, employees, teachers, and coaches harmless from any and all liability, causes of action, debts, claims, or demands of any nature whatsoever which may arise in connection with my child's participation in any activities related to the program. The terms hereof serve as a release. I, as the parent/legal guardian, have read the above warning and release.


Your Child's Class Position

Once you start your child in our program and pay membership, we consider your child enrolled. This means that your child automatically remains on the class rolls into all future months until you notify WVGS in writing that you are withdrawing your child. You may withdraw and re-enroll at any time throughout the year after initial Membership.

  • You may transfer or add classes at any time throughout the year wherever and whenever space is available – this must be scheduled through the Office.
  • If you drop your child for a period of time, but plan on returning – DO NOT assume your child can come back to his or her original class time, as we may have filled that position. Call the Office prior to your return to obtain class availability information.
  • If you are planning to Drop your child, be sure ALL Make Ups are done prior to the Drop Date. NO MAKE UPS will be honored after you have withdrawn from the program. (See Make Up Section)
  • Parents are not allowed on the floor at any time during their children’s class. Parent participation classes are the only exception.
  • Any persons on the premises, including your child, may be photographed in class or at WVGS events and the photographs may be posted on the WVGS facility and/or website.

Tuition, Fees and Procedures

WVGS requires Prepayment of Tuition and Fees through our Automatic Charge program. Charges to your credit card will be posted during the last week of the month for the next month. Charges will continue until you have notified WVGS in writing that you wish to cancel membership. You may avoid your credit card being charged by paying prior to our Automatic Charge date posted in the gym.

  • WVGS offers the following discounts: A Family discount of $10.00 off your 2nd and subsequent children’s class fees when paying full months fees. For children enrolled in more than one class per week-receive $10.00 off the 2nd class rate (not applicable to classes that meet multiple times per week as their normal format). Discounts are only available when accounts are Prepaid and when full months fees have been charged.
  • Tuition NOT PAID by the second class meeting and absence of your child for the first two weeks will result in your child losing his/her class position (AUTOMATIC DROP). When WVGS does an Automatic Drop, it does not relieve you of the financial responsibility already incurred. You are still responsible for payment through the date of Automatic Drop. If your child has attended all month however your account is not paid in full your child will also loose their class position for the next month. In this case you are still required to pay for the full months tuition in which your child attended. Timely tuition is the only way to secure a class position.
  • If you are no longer attending WVGS and have a outstanding balance, your account will be sent to our collections agency if your balance is not paid. You will be charged an extra $25.00 fee if you are sent to our collections agency.
  • You are required to pay for all classes up through the day you have given WVGS written notification of withdrawal or as of WVGS’s Automatic Drop date. Proof of notification is your responsibility. Please don’t rely on communicating verbally to the coaches or even the office staff. Request a written acknowledgement of your communication.
  • Tuition is considered paid on the date received by our office staff, not the date of the check. WVGS clears, posts and deposits our checks daily. Payments mailed must be received prior to the automatic payment date to receive any discounts. Please check at the office for these dates.
  • There is a $25.00 charge for the first time a check is returned to us and a $40.00 charge for the second time. WVGS will not redeposit your check. The only remedy for this oversight is CASH, or Charge, and must be paid by your child’s next class meeting.
  • All students are required to pay an annual $50.00 membership fee. This fee is paid at the time of enrollment and then again 12 months from when you first began. This charge is non-transferable and non-refundable. There are no family discounts on the Membership Fee – it is a per child fee.
  • Late pick-up charge: There will be a fee applied to your bill of $5.00 per 15 minutes that you are late for pick-up.
  • Your child may make up a missed class (see Make Up Policy); however, missed classes can not be transferred to future months in place of tuition. There are no fee adjustments for missed classes.
  • Absolutely NO REFUNDS are given. All gym credits given to a customer are non transferable between different families nor refundable.
  • The gym will be closed for posted holidays throughout the year. Class fees are not prorated when the gym closes due to holidays because on a yearly basis, the months with 5 classes make up for the holidays.

Make Up Policy

We believe it is important that our students attend their regular classes as much as possible. However, if a student must miss a class because of illness or any other excused absence, we do offer, as a courtesy, Make Up Classes. But please remember, A Make Up for a missed class is only allowed:

  • Once a month in the second week of the month during the school year (September through May). Make ups may be done once a week during the summer months (June through August). At the end of August we start over with a zero count for the next school year. There is no further credit given for unused make ups at that time.
  • If space is available, and only in age / level appropriate classes. You must make an appointment through the front desk for a Make Up class. Sign-ups are on a first-comefirst- served basis. Please Check with the front desk for current restrictions. No Make Ups are given to Team Competitors.
  • If you have paid a full months fees for classes in the current month. You MAY NOT do a Make Up lesson in the following month in place of tuition.

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