Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family and Information
First Name:* Last Name: *
Relationship to Student*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?*
How many $25 Gift Cards? 0-100
How many $50 Gift Cards? 0-100
How many $100 Gift Cards? 0-100
Would you like to pick up the Gift Cards at GymStars at no additional cost?*
Would you like us to ship the gift cards to you for an additional cost of $1 per card purchased?*
If you said yes, to the above questions, please type in your full address here.
Optional- Who are these Gift Cards intended for?
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*