Twist'N Flip Gymnastics Online Registration

Registration

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Welcome To The Twist'N Flip Gymnastics' Registration Form. Please read and complete this form entirely. All information obtained will be used to ensure proper registration will not be shared. If you have any questions regarding this form, please contact us.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family & Contact Information

Family Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name and Number*

Health Insurance Carrier*

OK to use photo of your child?*

Contact #1

Main Contact First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relationship

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

What do you expect your child to get out of our program?

List the name(s) and number(s) of anyone permitted to transport/care for your child

Medical Conditions/ Disabilities*

Special Needs*

Allergies/Sensitivities*

List and explain any medications/devices you or your child will have on hand during class*

Any history of head injuries, broken bones, sprains, fainting, seizures, etc?*

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

What do you expect your child to get out of our program?

List the name(s) and number(s) of anyone permitted to transport/care for your child

Medical Conditions/ Disabilities*

Special Needs*

Allergies/Sensitivities*

List and explain any medications/devices you or your child will have on hand during class*

Any history of head injuries, broken bones, sprains, fainting, seizures, etc?*

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

What do you expect your child to get out of our program?

List the name(s) and number(s) of anyone permitted to transport/care for your child

Medical Conditions/ Disabilities*

Special Needs*

Allergies/Sensitivities*

List and explain any medications/devices you or your child will have on hand during class*

Any history of head injuries, broken bones, sprains, fainting, seizures, etc?*

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

What do you expect your child to get out of our program?

List the name(s) and number(s) of anyone permitted to transport/care for your child

Medical Conditions/ Disabilities*

Special Needs*

Allergies/Sensitivities*

List and explain any medications/devices you or your child will have on hand during class*

Any history of head injuries, broken bones, sprains, fainting, seizures, etc?*

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

What do you expect your child to get out of our program?

List the name(s) and number(s) of anyone permitted to transport/care for your child

Medical Conditions/ Disabilities*

Special Needs*

Allergies/Sensitivities*

List and explain any medications/devices you or your child will have on hand during class*

Any history of head injuries, broken bones, sprains, fainting, seizures, etc?*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

AutoPay Schedule*

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 & Contact Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

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

Account Information

Credit Card

Required Policies

(Show-Hide Details)