Registration

Participants ages 5 and under need to have a parent present and participating during open gym.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

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

	Address: *
	City: *	State: * Zip: *

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:
	Disabilities (Leave blank if NONE):
	Allergies:*
	Medications:

Questions/Options:


Did you recieve an open gym discount code?*
If yes, enter your code here.

Additional Information:

Assumption of Risk

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I've read the above and agree.

Release of Liability

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I've read the above and agree.

Enter your Full Name: