Registration
Extended Fun Friday Parents Night Out/Open Gym 6:30 pm - 11:30 pm $40 per child (non-refundable) For boys & girls ages 5-13. No jewelry. Must wear athletic/flexible clothing. Includes pizza & Juice. Children may buy extra snacks and drinks in the Coca-Cola room. Each child is entered into a raffle for a backpack filled with school supplies. One girl and one boy winners. Everyone goes home with a goody bag. Activities with our certified instructors include gymnastics fun, obstacle course, group games, arts & crafts, table activities, and prizes for games!
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: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
What kind of dinner would your child(ren) like? Options are Pepperoni, Cheese, Hot Dogs. Multiple children: please list names and dinner type if not all the same. EX.: Mary Hot dog, Daniel Pep*
Are you redeeming any FREE OPEN GYM passes? Must present coupon to receive discount. If not received, the full amount will be charged.*
If Yes, what kind? ( Fully punched Fun Friday Loyalty card, Birthday coupon, $15 off discount only for each)
Is the child(ren) coming from the After School program, Camp or class directly to Extended Fun Friday? *
Questions/Comments
 
Additional Information:
 
Disclaimer/Waiver
I, parent or guardian am authorized to sign in the following children . I understand that any activity involving motion or height creates the possibility of serious injury, including permanent paralysis and even death from landing or falling on the head or neck. I hold Powerhouse TNT Gymnastics Inc. Brambila Management LLC and its coaches, staff, employees and owners harmless for any and all injuries arising out of participation in any and all classes and all activities in the gym and away from or at the gym. I understand that Powerhouse TNT Gymnastics Inc. is not a child care facility. I understand that the times for this event are from 6:30-11:30pm, unless otherwise published, and that there is a late fee of $10.00 for every 5 minutes that I am late in picking up my children.
I've read the above and agree.
 
Late Pickup Fee
I understand that the times for this event are from 6:30-9:30pm, unless otherwise published, and that there is a late fee of $10.00 for every 5 minutes that I am late in picking up my children.
I've read the above and agree.
 
Audio and Image Consent
By your attendance in class, you are granting your permission for you and your child to be filmed, audio taped, or photographed by any means and are granting full use of your likeness, voice, and words without compensation.
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:*