Registration
2 openings left in this 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:
 
Agreement
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'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:*