Registration

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This fun controlled gym setting for Preschool ages 18 months-5 yrs old. Children under the age of 3 yrs MUST be accompanied by a parent while in the gym. $10 non-refundable fee due upon enrollment. Pre-registration is required to attend. Enrollment is non-transferable.

Event:

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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 (Not Contact #1 or #2)*

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

Additional Information:

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:*