All That Cheer and Tumble 110 Haverhill Road Amesbury, MA 01913 (978) 388-3318 allthatcheerandtumble.com All That Summer Fun Clinic Registration Form 2008 *Early Bird Registration, pay in full by May 30th and receive a $25.00 discount. Name: _________________________________________________________________ Address: ________________________________________________________________ Parent Name: ____________________________________________________________ Home Phone: _____________Work Phone: _____________Cell Phone: _____________ E-mail: _________________________________________________________________ Clinic registering for: (please circle all that apply) Cheer Fun Activity Clinic, July 14-18 All About Cheer Clinic, July 21-25 “Kids Gym” Clinic with Kim, July 28-Aug 1 Free To Be 3 & 4 mini clinic Aug 5&6 "Big Kids Gym" Clinic, Aug 11-15 $75.00 non-refundable deposit is due for each clinic at the time of registration. Total amount paid at the time of registration $ __________________ Medical Information Allergies: _______________________________________________________________ Insurance Company/Policy # _______________________________________________ Primary Care Physician/Phone # ____________________________________________ Emergency Contact/Phone # _______________________________________________