Registration

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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: *

Students entered below will be added to your family's account

Add New Student #1:

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Questions/Options:


Your First and Last Name (Must be an adult)*
Relationship to Student/s (Mother, Father, Grandparent, Guardian...)*

Additional Information:

Symptoms

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