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NewFlex Youth Programs Inc.

250 South 6th Ave, Mt Vernon, NY 10550

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Membership Registrations

Please complete ALL required fields for registration OR APPLICATION WILL NOT BE PROCESSED-including LIABILITY.

You will be expected to submit the appropriate membership fee upon completion of this application. Afterwards failure to maintain fee will result in inability to participate in programs.

Monthly/Annual payments can be submitted below or via checks to 250 South 6th Ave, Mt Vernon, NY.

Help us make you and your YOUTH a part of our programs! how did you hear about our program

Parent/Guardian First & Last Name

Email Address

PhoneHome Phone #

Cell Phone #

YOUTH First Name, Last Name

YOUTH Phone# (if applicable)

YOUTH birthday: mm/dd/yyyy

Age

Current School and Grade

Address

City, State

Your child's prior involvements, brief assessment,

Please enter additional programs your child was or is currently involved in. This allows us to help in the development of their skills in our programming.

Mychild is interested in the following programs....

Your child's prior involvements

never played sportsBeginner basketballsome summer basketballvery athleticloves to dancevery extrovertedshyneeds a positive circle of friendsloves arts and craftsneeds additional help with readingwill enjoy going to various trips

My Child will be participating in:

I will be a TEAM PARENT/CHAPERONE/VOLUNTEER

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WAIVER OF LIABILITY I hereby release and discharge NewFlex Hoops, the hosting school and affiliated entities, and their respective officers, servants, agents or employees from any and all liability whatsoever arising out of or in connection with my participation, or my child’s participation in the NewFlex Hoops Clinics, Open Gym, or Other activity. (minors must have this permission slip completed by parents or legal guardians) . Submit child's name and his/her birthdate along withparent/guardian name, email, and date, as signature approval

I hereby authorize use of my child's pictures or videos, taken during involvement in NewFlex events, to be used for promotional purposes (website, brochures, etc.). Submit child's name and birthday and parent/guardian name, email, and date as signature approval

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*******MONTHLY FEES CAN BE SUBMITTED VIA CREDIT CARD OR PAYPAL: NOTE MEMBERSHIP WILL NOT BE VALID WITHOUT RECEIPT OF FEE & COMPLETION OF WAIVERS BELOW******

Limited Annual Membership

Includes one practice site a week

Limited Annual Membership

$80.00

Annual Premium Membership

Includes access to 2 onsite practices-at registered location, (costs does not include additional programming)

Annual Premium Membership

$160.00

Single Workout Session

one workout session for week at registered site

Single Workout Session

$20.00

HOOPS TEAM REGISTRATION

by selection only--this price still pending-

HOOPS TEAM REGISTRATION

$150.00

HOOP TEAM WKOUTS/mntly

open to community does not include team membership and 1 wkout session a week-terms pending...

HOOP TEAM WKOUTS/mntly

$35.00

Click On Links ADDITIONAL PROGRAMS:

For General Membership--See Below

TENNIS 2016 (NEW)

nonmembers complete application below and submit fee

ages 8-16

SPRING PROGRAM

Registration

*SUMMER PROGRAM-full day tbd

Registration

**SUMMER SCHOLARSHIPS

*SUMMER CAMPING RETREAT

Registration

*SUMMER BASKETBALL SPEED and AGILITY PROGRAM

*TEAM HOOPS 6U(NEW)

* HAIR SHOW PRINCESS PAGEANT

Registration 2016

*XFACTOR DRUM SHOWDOWN Registration 2012

email us at [email protected]

office: 914-595-4257

OFFICE 914-363-5460

OFFICE 716-393-5399

Or send in signed application to one of our listed offices:

The Dole Center: 250 South 6th Ave.Mt Vernon, NY ,10550

Wyanoke St. White Plains NY 10606

416 Chauncey St. Brooklyn NY, 11233

Please complete ALL required fields for registration.

You will be expected to submit the appropriate membership fee upon completion of this application. Afterwards failure to maintain fee will result in inability to participate in programs.

Monthly/Annual payments can be submitted below or via checks to 250 South 6th Ave, Mt Vernon, NY.