Registration
Trampoline, Tumbling, Ninja Obstacles, and Gymnastics
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
 
Questions/Options:
Make-up Class? Please add the date of class you're making up. (A $22 credit will be applied to your account.)
Location - 140 Long Road, Suite 121,Chesterfield (checked=yes)
 
Additional Information:
 
Release of Liability
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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:*