Registration
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Welcome to Anchorage Gymnastics Association!
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Referral Information
How did you hear about us?
Friend
Referral Name
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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DE
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Zip
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Primary Phone
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Additional Info
Emergency Contact Info (Not Contact #1 or #2)
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Contact #1
Contact #1 First Name
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Last Name
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Relationship to Student
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Caregiver
Father
Guardian
Mother
Parent
Self
How Can We Contact You?
Work #
Cell #
Portal Access (your email is your login)
Email
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(Emails are kept confidential)
Confirm Email
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Portal Account Password
Confirm Portal Account Password
Who is your employer?
Employer
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Employer Phone
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Employer Notes
Contact #2
Contact #2 First Name
Last Name
Relationship to Student
Caregiver
Father
Guardian
Mother
Parent
Self
How can we contact you?
Home Phone
Work #
Cell #
Email
(Emails are kept confidential)
Confirm Email
Who is your employer?
Employer
Employer Phone
Employer Notes
Student #1
Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Small
School
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Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Primary Doctor
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Student #2
(Show-Hide Details)
Student's First Name
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Last Name
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Student Gender
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Female
Male
Birth Date
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Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Small
School
*
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Primary Doctor
*
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Small
School
*
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Primary Doctor
*
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Small
School
*
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Primary Doctor
*
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Child Large
Child Medium
Child Small
Child X-Small
School
*
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Primary Doctor
*
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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September 7, 2024
Questions or Concerns
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Payment Information
Account Information
e-Payment Schedule
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Address Line 1
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City
State
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DE
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IA
ID
IL
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MA
MD
ME
MI
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MT
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NH
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Zip
eCheck/Bank Draft
Bank Name
Account Type
Checking
Savings
Your Account Name
(Your name on your bank statement)
Bank Routing Number
(9-digit number)
Account Number
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