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					                  LANSING RECREATION GYMNASTICS PROGRAM
                                                WINTER 2011 new Session 3
PLACE:                   Fingerlakes Gymnastics Academy (You MUST sign FLGA waiver on back of this form)!

DATES:                   Session 3 – FRIDAY          afternoons March 4, 11, 18, 25 April 1, 8.
                         *There is an early dismissal on March 25th. You will need to bring your child back to school for the bus.
FEE:                     $75 per session - Make checks payable to LANSING RECREATION
CLASS SIZE:              A maximum of 40 students will be accepted on a first come, first served basis. A minimum of 20 students
                                                                                                             th
                         will be needed to run the program. Registration Deadline is Monday February 8 .
The Town of Lansing Recreation Department and the Fingerlakes Gymnastics Academy are offering a gymnastics program for
boys and girls in Grades K-4. The qualified and certified staff at Fingerlakes Gymnastics Academy will help your child learn
safely and correctly.
Program: Students will learn their gymnastic skills using the USA Gymnastics Developmental program. The four-level
program has been designed to help young gymnasts learn with the potential to advance to a competitive level. The Fingerlakes
Gymnastics Academy is an 8,400 square foot state-of-the-art facility. Special features include an in-ground trampoline and 400
square feet of in-ground landing pits.
Transportation: School bus transportation will be provided, departing from the elementary school at 3:15 pm. Actual
instruction will be from 3:45-4:45 at FLGA. ALL CHILDREN will be returned to the elementary school at 5:20 pm.
PARENTS MUST BE ON TIME TO TAKE CHILDREN HOME.
          Please return your form and fee to the Recreation Department. Participants accepted first come – first served.
---------------------------------------------------------------------------------------------------------------- --------------------------------------------------

      LANSING RECREATION WINTER GYMNASTICS PROGRAM 2011                                                                                         Session 3
                                 !! You MUST sign the FLGA waiver on the back side of this form !!
NAME: _____________________________________________________________________________________________________________________


AGE: _______                     GRADE: _______           EMAIL __________________________________________________________


PARENT’S NAME: ___________________________________________________________________________________________________________


ADDRESS: __________________________________________________________________________________________________________________


HOME PHONE: ______________________________WORK PHONE: ___________________________CELL PHONE: ______________________

I attended SESSION 1 in the fall: _______ yes          ________no          Please sign FLGA waiver on back of this form!
BY SIGNING THIS FORM, THE PARENT AGREES NOT TO HOLD THE TOWN OF LANSING, OR ANYONE CONNECTED WITH THIS
PROGRAM, RESPONSIBLE FOR ANY ACCIDENTS OR INJURIES SUSTAINED IN CONNECTION WITH THIS PROGRAM. THE PARENT
ALSO GIVES PERMISSION FOR THE PARTICIPANT TO BE TREATED BY EMERGENCY MEDICAL PERSONNEL IN CASE OF AN
EMERGENCY.

PARENT OR GUARDIAN SIGNATURE: _______________________________________________________Date:_______________________

Please return this form and fee to the Lansing Town Hall, Box 186, Recreation Dept., 29 Auburn Road, Lansing, NY 14882. A drop box is located in
the door of the Town Hall for your use after business hours.

_______________________________________________________________________________________________________________________________
For official use only:
                                 Cash________         Check # ____________ _   Visa/Master:_____________________________________________

				
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posted:7/25/2011
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