GymStars Gymnastics - Stockton Online Registration

Registration

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You are registering for classes at GymStars Stockton. To complete the registration process, please fill in the required fields. If the answer to the question is "None", please indicate so by typing: None or N/A. All registrations will be reviewed by GymStars Customer Service prior to charging your credit card. Please carefully read all policies listed below.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family and Information

Family (Primary Contact's) Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?*

Students Health Insurance Carrier & Policy Number*

Credit Card Billing address*

Form Completed in GymStars Y-N*

Coupon Code if applicable

Contact #1

Family Contact First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Home Phone *

Work #

Cell #

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from GymStars Gymnastics - Stockton. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Secondary Contact First Name

Last Name

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from GymStars Gymnastics - Stockton. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Any Disabilities we should be aware of?*

Does the student have any Special Needs?

Does the student have any medication intolerances or allergies (whether environmental or medical)?*

Does the student require any special medications?*

Who is the Students primary Doctor & Phone number?*

May we use child's image?*

Trial Class Only ? (Yes or No)*

If you are new to GymStars you may enroll your child into a Trial Class. Select the class you would like your child to try. The system says we will charge you for a full month of tuition however we will correct that prior to your credit card or financial institution being charged. Our Trial Class Fees range from $17.00 to $52.00 depending on the program. We do credit your account if you enroll into class the same day as the trial class. Karate tuition rates maybe adjusted.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Any Disabilities we should be aware of?*

Does the student have any Special Needs?

Does the student have any medication intolerances or allergies (whether environmental or medical)?*

Does the student require any special medications?*

Who is the Students primary Doctor & Phone number?*

May we use child's image?*

Trial Class Only ? (Yes or No)*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Any Disabilities we should be aware of?*

Does the student have any Special Needs?

Does the student have any medication intolerances or allergies (whether environmental or medical)?*

Does the student require any special medications?*

Who is the Students primary Doctor & Phone number?*

May we use child's image?*

Trial Class Only ? (Yes or No)*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Any Disabilities we should be aware of?*

Does the student have any Special Needs?

Does the student have any medication intolerances or allergies (whether environmental or medical)?*

Does the student require any special medications?*

Who is the Students primary Doctor & Phone number?*

May we use child's image?*

Trial Class Only ? (Yes or No)*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Any Disabilities we should be aware of?*

Does the student have any Special Needs?

Does the student have any medication intolerances or allergies (whether environmental or medical)?*

Does the student require any special medications?*

Who is the Students primary Doctor & Phone number?*

May we use child's image?*

Trial Class Only ? (Yes or No)*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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Registration

Referral Information

Family and Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

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