Registration
Take ANY 15 Adult Aerial, Dance, Fitness, or Pilates classes, expiration 12/31/2025
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Release of Liability
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I've read the above and agree.
 
Assumption of Risk
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I've read the above and agree.
 
Medical Emergency
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I've read the above and agree.
 
Media Release
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I've read the above and agree.
 
Indemnification Clause
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*