Registration
ALL CHILDREN MUST BE ENROLLED AND PAID IN FULL BEFORE THE EVENT
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:
 
As the parent or legal guardian of the attached student account, I agree to hold harmless from any and all liability the Gym Zone, it's members, officers or employees, both in their professional capacity and personally for any or all injury or illness resulting from participation in open gym, classes, and special events at the Gym Zone.

I understand that it is the Gym Zone's policy that while under supervision of the Gym Zone, no child is allowed to leave the building without a parent/legal guardian of the written permission of a parent/legal guardian. The parent/legal guardian assumes full responsibility of the actions and behavior of the student. I further understand that while my student participates in any class, gym or special events; he/she must follow all guidelines and rules for safety purposes. Students may be removed from the gym for safety reasons if not obeying rules & guidelines set forth by staff, instructors, and employees.

Parent/legal guardians give their permission to the Gym Zone to use photos or video of their student without remuneration in connection with Gym Zone publications, website or Facebook advertising.

Payments for Workshops, Open Gym, & Patents' Night Out events are due upon registration. Registrations made online will be processed upon staff review for correct fee posting.

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:*