Register

1Rising Star Academy Registration

2 Release of Liability & Waiver

3Tuition/Payment Policies

Parent Information

(if student is under 18)

Primary Parent/Guardian Name*

First Last

Phone Number*

Parent's Email*

Secondary Parent/Guardian Name

First Last

Phone Number

Parent's Email

Are there any court ordered custody or visitation arrangements to consider?*

Yes

Please explain further details to consider*

Emergency Contacts

The following named people are to be contacted should COA staff be unable to reach a parent/guardian named above, and shall be authorized to act on behalf of the parents/guardians in their absence:

Emergency Contact Information*

Name

Phone number

Relationship To Student

Medical Information

To provide your student with a positive experience PLEASE disclose any known medical or mental conditions that may require our attention:*

Allergies

Medications/Dosages

Student's Physician*

Phone*

Insurance Company*

Name Of Insured*

Policy #*

ID#*

Relationship To Student*

Student's Information

Student's Name*

First Last

Student's Date of Birth*

Month

Day

Year

Grade*

(as of August 31, 2023)

Address*

Street Address City ZIP / Postal Code

Student's Gender*

Male

Female

Prefer Not To Answer

Other

Student's T-shirt Size*

Does student have difficulty learning or retaining information?*

Yes

Choose Your Package

Select a monthly class option of 1 class, 2 classes, or unlimited classes.

Annual Registration Fee*

Price:

Do you qualify for Military Pricing?*

(Be prepared to show proof on first visit)

Yes

Select Your Registration Option (Military)*

Select Your Registration Option*

CLASS SELECTION*

Choose Only 1 of The Following

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

CLASS SELECTION (MILITARY)*

Choose Only 1 of The Following

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

CLASS SELECTION*

Choose Only 2 of The Following

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

CLASS SELECTION (MILITARY)*

Choose Only 2 of The Following

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

CLASS SELECTION*

Unlimited Class Selection

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

CLASS SELECTION (MILITARY)*

Unlimited Class Selection

BEGINNER 1 TUMBLING

BEGINNER 2 TUMBLING

INTERMEDIATE TUMBLING

TINY TOTS TUMBLING

TUMBLING FUNDAMENTALS

ADVANCED TUMBLING

HIP-HOP 101

HIP-HOP 102

MAJORETTE 101

MAJORETTE 102

INTRO TO DANCE

DANCE FUSION

DANCE TECHNIQUE 1

DANCE TECHNIQUE 2

ADV. CHEER CHOREO, JUMPS, & DRILLS

BEG/INT. CHEER CHOREO, JUMPS, & DRILLS

CHEER 365

BEG/INT. STUNT SCHOOL

ADVANCED STUNT SCHOOL

TWIST & SHOUT TUMBLING

Medical Authorization and Liability Release*

I authorize COA Elite and its representatives to consent to medical treatment for my child when I cannot be reached to give consent. I am fully aware that any activity involving motion, height, or athletic exercise creates the possibility of serious injury, paralysis, or even death. I further agree to hold COA Elite and its staff harmless for any injury or resulting expense(s). I release and discharge all rights and claims against COA Elite, and its parties. COA Elite strives to provide the maximum in safety procedures and guidelines, and cannot assume responsibility for any accidents, injuries or illness that may occur.

Authorization to obtain medical treatment if necessary for athlete (18 or older) or authorization from parent or guardian if he/she is not available to make this decision (if under 18).**

I give FULL PERMISSION to COA Elite LLC, its Owner(s), Director(s), Staff, Employee(s), Independent Contractor(s), and/or Volunteers, the legal right to choose or decide what medical attention be provided, should the need arise, when the student(s) cannot make this decision (if under 18 years of age) or parent/guardian for the student(s) under 18 years of age is not present to make this decision.

Parent Consent*

The student listed above has my permission to participate in the COA Elite program and or camp for the 2023-2024 year. In consideration for the training and coaching provided by COA Elite and its staff, I understand that my son/ daughter must abide by the rules and regulations set forth by the coaches and staff. I understand that violations of any of these rules may result in removal from the classes and or events. We acknowledge and recognize that hazards are present in any athletic event and that injury may result. COA Elite coaches, staff and volunteers will not be liable for injury that occurs during cheerleading practice, and contests.

Signature*

Tuition/Payment Policies*

Tuition is due on the 25th for the upcoming month.   Tuition is Auto-Debited through iClassPro, our class management software ON the 25th of each month.   I understand that a $35 NSF will be applied for each unsuccessful Auto-Debit.   I understand and agree to allow COA Elite to charge my debit/credit card according the outlined payment dates. I may pay in cash in advance of payment due date to avoid Auto-Debit of my account.   I am obligated to make timely payments. While communication regarding late payments is expected as a courtesy, it doesn’t automatically result in the waiver of late fees.   Any discrepancies on my account should be brought to COA’s attention via email at admin@coaelite.com.

RECITAL FEE/COSTUME COSTS*

Rising Star Recreational Program students will participate in an end of the year showcase/recital. A recital fee of $285 will be due January 1st.*

REQUEST TO CHANGE SCHEDULE OR OPT OUT*

Thirty (30) days written notice is required for all requested changes in schedule or if you would like to opt out of this Agreement here. If no notice is provided, this Agreement will continue to be in effect and monthly charges still apply.*

REFUNDS*

There are NO REFUNDS for missed classes, changed schedules, recital fees, or termination of this agreement unless agreed upon by COA.*

COLLECTION OF PAST DUE ACCOUNTS*

Accounts that are thirty (30) days past due will be placed on pre-collection status. Once an account becomes sixty (60) days past due the outstanding balance will be sent to collections. COA may, in its discretion, retain a collection agency and/or attorney to collect past due balances. The Responsible Party understands and agrees they will assume all financial responsibility of COA’s collection costs to include fees paid to collection agencies and/or attorneys, whether or suit is brought or not, to include all pre/post collection/lawsuit costs.*

NON-DISCLOSURE AGREEMENT*

Students, family members, or any other Representative agree not to disclose or reproduce any information regarding gym operations, choreography, staging, music, costumes/uniforms, designs, client lists, student information and/or family contact information. This information is the property of COA.*

RESPONSIBILITY AGREEMENT*

The student, family member, or any other person associated with the student, who enters gym or any other premises used by COA will be held responsible for any and all of their actions to include any or all damage to or loss of property belonging to COA, whether owned or rented, or any other person or party. The Responsible Party agrees to and will assume financial responsibility for the repair and/or replacement of any damaged and/or lost property of COA or any other party*

COA’s RIGHT TO MAKE CHANGES*

COA reserves the right to make changes to class schedules, instructors, performances, company events, etc., at any time.*

All registered students are required to have a credit card on file. The credit card will be billed on the 25th of every month. To avoid charges to the credit card all invoices must be PAID IN FULL on the last business day PRIOR to the 25th of the month. A $35 late fee will be assessed and automatically charged to the Responsible Party if payment is not available during auto-debit attempt. If payment has not been received by the 10th of each month, the student will not be able to attend class until tuition and the late fee has been paid.

**If there is a waiting list for the enrolled class your student will be bumped at the end of the month if tuition remains unpaid. All past due fees are still due to COA. **

Consent*

I, the Student (if 18 or older), or Parent/Guardian (for students under 18 years of age) have filled out this form accurately. I have read, understand, and fully accept all sections, terms, and conditions of this Agreement.*

Signature*

Payment Information

Consent*

I understand and authorize COA to charge my credit card for my monthly tuition payment and/or other fees such as late charges and/or annual registration costs. All payments are due on the 25th of every month. If my monthly tuition has not been received prior to the deadline (described above), I authorize COA to charge the monthly tuition and late fee to my credit card.*

Total

Credit Card*

*A 3% credit card processing fee is added to each credit card transaction. **

Card Details

Cardholder Name

Register HERE

Parent Information

Emergency Contacts

Medical Information

Student's Information

Choose Your Package

Payment Information