Registration

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Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family and Information

	First Name:*	Last Name: *
	Relationship to Student*
	Home Phone:*	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?*

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:
	Any Disabilities we should be aware of?:*
	Does the student have any medication intolerances or allergies (whether environmental or medical)?:*
	Does the student require any special medications?:*
	Who is the Students primary Doctor & Phone number?:*
	May we use child's image?:*
	Trial Class Only ? (Yes or No):*

Add New Student #2:

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Questions/Options:


How many programs for this child are you registering to perform in for the Winter Showcase?*
What is your child's class(es), day(s) and time(s)?*
Do you have more than 1 child in your family who is registering for the Mini Olympics?*
If you answered Yes to the previous question, please, give us the name(s) of the child(ren).
I prefer morning, afternoon or evening show time. (please, note, this preferences can not be guaranteed).
What size Leotard, shirt or shirts does your child wear? Type N/A if not applicable*
I will be be coming in to try on a leotard at the front desk during my next class.*

Additional Information:

Payment Policy Terms and Conditions

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Tuition is due on the 15th of the month for the following month. If you choose to pay your balance manually you must do so by the 15th of the preceding month. If you have a balance on your account as of the 16th of the preceding month we will engage the Auto Pay System. You will notice your automatic payment debit or charge between the 17th and the 20th. Should your bank decline or your card company decline the charge to debit a $45.00 fee will be charged to your account and is immediately due. At this time you must pay your account current. The system will attempt to process your auto pay several times prior to the end of the month. If your account is not paid in full by the end of the month a $25.00 late fee will be added to your account. Your account balance will be immediately due and payable. The system will attempt to process your auto pay one more time between the 1st and the 5th. If you still have a balance your child will be un-enrolled from class. (To avoid this please call us to make satisfactory payment arrangements prior to the end of the month.) I (we) hereby authorize GymStars Gymnastics, Inc., or assignee hereinafter called COMPANY, to initiate debit entries to my (our) account and financial institution on the voided check or credit card number provided to pay the balance due on my GymStars account. Transfer of funds will occur on the 20th of every month or the prior banking day dependent on the hours and days of operation of the COMPANY and attempted several times between the 20th and the 5th is the first attempt is rejected. This authorization is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of it's termination no less than 15 days prior to the due date as to afford the COMPANY a reasonable opportunity to act on it. Please review the Auto Pay policy found on our website. By clicking "I've read the above and agree" you certify that you have read and agree to the Payment Policy Terms and Conditions.