Registration
Upon entry to Rebounders facility for the first class/practice, we ask that all students' parent/guardian complete this one time screening questionnaire for family. In answering 'YES" to these questions, you acknowledge that you will not send your child to class if he/she shows any COVID related symptoms, has been in close contact with anyone who has tested positive within 14 days of your child's class, or is awaiting a COVID test result. Please click on the Questionnaire link for the day that your student attends class. On the top of the form, click on "Already a Customer" to complete the questionnaire using your member portal. Please note: If you have students on different days please complete the questionnaire for that day as needed. Please ignore that the December Date on the form.
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 Perrson and Phone #
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Your First and Last Name (Must be an adult)*
Relationship to Student/s (Mother, Father, Grandparent, Guardian...)*
 
Additional Information:
 
Symptoms
  (Show-Hide Details)
I've read the above and agree.
 
Close Contact with Positive Case
  (Show-Hide Details)
I've read the above and agree.
 
Awaiting a Test Result
  (Show-Hide Details)
I've read the above and agree.
 
Positive Case
  (Show-Hide Details)
I've read the above and agree.
 
Temperature Screening
  (Show-Hide Details)
I've read the above and agree.
 
Mask
  (Show-Hide Details)
I've read the above and agree.
 
Other Items to Bring
  (Show-Hide Details)
I've read the above and agree.
 
Observation Guidelines
  (Show-Hide Details)
I've read the above and agree.
 
Entrance & Exit
  (Show-Hide Details)
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: