Registration
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Current classes online are for our 2013-2014 session: September 2013 through August 2014. An annual membership fee of $40 per family is due at the time of registration and is valid through August. The membership fee is prorated throughout the year. Membership fees are non refundable. Gymfinity encourages every family to have valid credit card information on file. Families that choose not to provide credit card information will incur a $5 monthly fee in addition to monthly tuition.
How did you hear about us? *   Referral Name:         * - denotes required fields
Family Information:
Family Name:
Contact #1 First Name:* Last Name: * Type:*
Home Phone: * Cell #: Work #:
Email:* (Emails are kept confidential)
 
Contact #2 First Name: Last Name: Type:
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Home Address: *
City: * State: * Zip: *
Home Phone: *
Emergency Contact Info:*
(Not Contact #1, Contact #2)
Health Insurance Carrier:
When would you like to start?:*
 

Student #1 Information:
Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy)  
School: Grade Level:
Disabilites:*
Special Needs:
Allergies:*
Medications:*
Primary Doctor:
Tuition is based on a flat monthly fee. Class days can vary between 3-5 times per month. Withdrawal forms are due by the 20th of the current month to stop billing for the next month. Families that fail to complete a written request by the 20th of the month will be liable for the following months tuition, and will be subject to a $25 late withdrawal fee.

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #2 Information:
Show-Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
School: Grade Level:
Disabilites:*
Special Needs:
Allergies:*
Medications:*
Primary Doctor:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #3 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
School: Grade Level:
Disabilites:*
Special Needs:
Allergies:*
Medications:*
Primary Doctor:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #4 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
School: Grade Level:
Disabilites:*
Special Needs:
Allergies:*
Medications:*
Primary Doctor:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #5 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
School: Grade Level:
Disabilites:*
Special Needs:
Allergies:*
Medications:*
Primary Doctor:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   
 
Enter your Full Name: *   
 
 
Comments:  

e-Payment Schedule:*  
Credit Card Verification:
   
Name as it appears on card: *  
Card Type: *   Card Number: *  
Card Expiration Month: *   Exp Year: *  
 
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