Author: Owner

Class Code
_____________

REGISTRATION
J & T CARTER, L.L.C. dba MAT TROTTERS GYMNASTICS

Today’s Date
_____________

Student Information
Name: ____________________________________ (M or F) Date of Birth: ____/ ____/ ____
Address: _________________________________ City: _______________ State: _____ Zip: ___________
Home Phone: ____________________ Parent’s Email (please print clearly): ___________________________
Mom’s Name: ______________________________ Occupation: _________________________________
Work Phone: ________________________ Cell: ________________________
Dad’s Name: _______________________________ Occupation: _________________________________
Work Phone: ________________________ Cell: ________________________
How did you hear about us? (If word of mouth, from whom?) _______________________________________
IN CASE OF EMERGENCY CONTACT: ___________________________ Phone: _____________________
Photos may occasionally be taken of students. Is Mat Trotters free to use these photos for our website or display? Y or N

Payment Information
Annual Administration/Registration fee (non-refundable) - $30
(unless paid within the last 12 months) $ __________
Tuition—based on 4 weeks (Full payment is required unless it’s being pro rated) $ __________
TOTAL ENCLOSED (payment may be made by cash, check, or credit card) $ __________

Release, To J&T Carter, L.L.C. dba Mat Trotters Gymnastics
I, intending to be legally bound, do hereby waive, release and forever discharge J&T CARTER, L.L.C. dba MAT TROTTERS GYMNASTICS, and/of any involved personnel or representative from any and all right of action and claims for damages or injury sustained by my child in practice, exhibition, competition, open workout, or clinic in tumbling, cheerleading and gymnastics events; and for travel to and from said events.
I understand the risks involved in training, participating and traveling; and I give my consent to have first aid administered and to provide the necessary medical treatment in case of accident or injury to my child.
I further agree to release J&T CARTER, L.L.C. dba MAT TROTTERS GYMNASTICS and any of its designated personnel or representatives from any liability and/or responsibility in the event of injury to said
participant.
______ I have received a copy of Mat Trotters Policies.
Signature of Parent/Guardian: _____________________________ Date: _________

Mat Trotters Gymnastics • 7009 N.W. 63rd • Oklahoma City, OK 73132
ph: (405) 722-0808 • website: www.mattrotters.com