Registration
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This 1/2 day camp is sure to be the highlight of the day! Kids will start with group stretch, games and gymnastics followed by snacks, crafts and more! Work towards your goals, make friends and have fun!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
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
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NJ
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OH
OK
OR
PA
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SC
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TN
TX
UT
VA
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WA
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WV
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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:
*
Birth Date:
*
(format=mm/dd/yyyy)
Does your child have any special accommodations, medical conditions, or learning needs:
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Does your child have any special accommodations, medical conditions, or learning needs:
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Does your child have any special accommodations, medical conditions, or learning needs:
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Does your child have any special accommodations, medical conditions, or learning needs:
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Does your child have any special accommodations, medical conditions, or learning needs:
Questions/Options:
Does your child currently attend classes?
Please list any allergies we should be aware of. Food, drink, latex, adhesive, etc.
Additional Information:
Assumption of Risk & Release of Liability
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CAUTION: ANY ACTIVITY INVOLVING HEIGHT OR MOTION CREATES THE POSSIBILITY OF SERIOUS INJURY, INCLUDING PERMANENT PARALYSIS AND EVEN DEATH FROM LANDING OF FALLING ON THE HEAD OR NECK.
As the legal guardian for the child registered on this form, I consent for him/her to participate in gymnastics classes conducted by Central Virginia Gymnastics. I recognize any activity involving height or motion can create the possibility of serious injury including permanent paralysis and even death from landing of falling on the head or neck. I forever release Central Virginia Gymnastics, Central Virginia Gymnastics managers, agent and employees from all liability and for any damages and injuries suffered or contracted as a result of participation in gymnastics classes at Central Virginia Gymnastics.
I've read the above and agree.
Pick Up/Drop Off Policy
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I understand that this camp is 9:00am-12:00pm. Participants may be dropped off or picked up 15 minutes before of after, children who are dropped off earlier than 8:45am or later than 12:15pm may incur a late pick up fee of $20.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
*
Add Credit Card
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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