EMERSON REGISTRATION FORM
CHILD’S NAME _________________________________________________________
AGE___________
ADDRESS______________________________________________________________
PARENT’S NAME________________________________________________________
PHONE #_______________________________________________________________
E-mail_______________________________________
VISA__________MASTERCARD__________CASH__________CHECK___________
NUMBER_______________________________________________________________
EXP DATE__________
I am enrolling for 1st choice:
DAY: _______________TIME: _______________
I am enrolling for 2nd choice:
DAY: _______________TIME:
PLEASE READ AND SIGN:
I certify that the above named Enrollee
has no condition that prohibits full participation in classes at Tumble Bee of Emerson.
I assume all ordinary risks when using the facilities and agree not to hold Tumble Bee of Emerson or any of it’s
instructors or employees liable for injury or damage which may occur to me as a result of my participation in classes or related
activities at Tumble Bee of Emerson. In case of accident, I give Tumble Bee of Emerson its agents and employees to contact,
and if necessary, obtain needed medical attention for my child. I understand
and accept all enrollment conditions.
Signature: ______________________________________Date:
____________________
MAIL TO: TUMBLE
BEE OF EMERSON, 465 Old Hook Rd., Emerson, NJ 07630
http://tumblebee2.tripod.com