Registration
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Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family and Information
First Name:
*
Last Name:
*
Relationship to Student
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Any Disabilities we should be aware of?:
*
Does the student have any medication intolerances or allergies (whether environmental or medical)?:
*
Does the student require any special medications?:
*
Who is the Students primary Doctor & Phone number?:
*
May we use child's image?:
*
Trial Class Only ? (Yes or No):
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Any Disabilities we should be aware of?:
*
Does the student have any medication intolerances or allergies (whether environmental or medical)?:
*
Does the student require any special medications?:
*
Who is the Students primary Doctor & Phone number?:
*
May we use child's image?:
*
Trial Class Only ? (Yes or No):
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Any Disabilities we should be aware of?:
*
Does the student have any medication intolerances or allergies (whether environmental or medical)?:
*
Does the student require any special medications?:
*
Who is the Students primary Doctor & Phone number?:
*
May we use child's image?:
*
Trial Class Only ? (Yes or No):
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Any Disabilities we should be aware of?:
*
Does the student have any medication intolerances or allergies (whether environmental or medical)?:
*
Does the student require any special medications?:
*
Who is the Students primary Doctor & Phone number?:
*
May we use child's image?:
*
Trial Class Only ? (Yes or No):
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Any Disabilities we should be aware of?:
*
Does the student have any medication intolerances or allergies (whether environmental or medical)?:
*
Does the student require any special medications?:
*
Who is the Students primary Doctor & Phone number?:
*
May we use child's image?:
*
Trial Class Only ? (Yes or No):
*
Questions/Options:
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?
*
Yes
No
Would you like us to ship the gift cards to you for an additional cost of $1 per card purchased?
*
Yes
No
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:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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