Registration
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Open Gym / 6:30-8:30 pm / Ages 5-14 (All children must be potty trained)
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
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MO
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MT
NE
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NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Disabilities (Leave blank if NONE):
Allergies:
*
Medications:
*
Primary Doctor:
*
Photo release (Y/N):
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Disabilities (Leave blank if NONE):
Allergies:
*
Medications:
*
Primary Doctor:
*
Photo release (Y/N):
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Disabilities (Leave blank if NONE):
Allergies:
*
Medications:
*
Primary Doctor:
*
Photo release (Y/N):
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Disabilities (Leave blank if NONE):
Allergies:
*
Medications:
*
Primary Doctor:
*
Photo release (Y/N):
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Disabilities (Leave blank if NONE):
Allergies:
*
Medications:
*
Primary Doctor:
*
Photo release (Y/N):
*
Questions/Options:
Who will be picking up your child? (ID required)
*
Additional Information:
Release of Liability
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You (the guest) are aware that you are engaging in physical exercise and that the use of exercise equipment, club facility training, and instructions, could cause injury to you. You are voluntarily participating in these activities and assume all risks of injury that might result. You agree to waive any claims or rights you might otherwise have to sue the facilities owner, office staff, and employees. You agree to waive and recommend whether you are sufficiently physically fit for any exercise activities. It is always advisable to consult your physician before undertaking a physical exercise program.
I've read the above and agree.
Discipline
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Multiple behavioral issues may result in parent having to pick their child/children up early with no refund. After verbal warnings, the child will be asked to sit out and if poor behavior continues, parents will be asked to pick their child up.
I've read the above and agree.
Late Pickup
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All children must be picked up on time. Parents who are late will be charged a late fee of $10 every 10 minutes.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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