The Kid's Gym Online Registration

Registration

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Welcome! We are so excited that you have decided to join our family here at The Kid's Gym. Before you can join in on all of the fun, we'd love to know more about you!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact

Contact #1

First Name*

Last Name *

Relationship*

How Can We Contact You?

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from The Kid's Gym. 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

First Name

Last Name

Relationship*

How can we contact you?

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from The Kid's Gym. 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*

Gender*

Birth Date*

Additional Info

School

Grade Level

Does your child have an special needs that we should be aware of?*

Does your child have any allergies we should know about?

Before finalizing your registration, please make sure that you have selected the correct class.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

School

Grade Level

Does your child have an special needs that we should be aware of?*

Does your child have any allergies we should know about?

Before finalizing your registration, please make sure that you have selected the correct class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

School

Grade Level

Does your child have an special needs that we should be aware of?*

Does your child have any allergies we should know about?

Before finalizing your registration, please make sure that you have selected the correct class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

School

Grade Level

Does your child have an special needs that we should be aware of?*

Does your child have any allergies we should know about?

Before finalizing your registration, please make sure that you have selected the correct class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Additional Info

School

Grade Level

Does your child have an special needs that we should be aware of?*

Does your child have any allergies we should know about?

Before finalizing your registration, please make sure that you have selected the correct class.

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*

Registration

Referral Information

Family 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

(Show-Hide Details)