Registration

Drop the kids off at Reflex Gymnastics for a night of Dancing, Gymnastics, Games and tons of FUN!!! Girls & boys ages 5 & up $15 - Pre Registered $20 - At the Door Proceeds go to NLP PTA!
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
 
Additional Information:
 
Please read this Liability Release Form
The undersigned gives permission for the Reflex Gymnastics owners, officers, employees, and/or agents to seek emergency medical treatment for the participant(s) in the event they are unable to reach any parent or guardian. The undersigned also agrees that they themselves will be responsible for any financial debt incurred by said action.
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:*