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Open Gym 12pm - 1:30pm - Age 4 (potty trained) - 17 - Please bring a water bottle for your child.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
Sister
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
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Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Allergies:
*
Medications:
*
Primary Doctor:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Allergies:
*
Medications:
*
Primary Doctor:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Allergies:
*
Medications:
*
Primary Doctor:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Allergies:
*
Medications:
*
Primary Doctor:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Allergies:
*
Medications:
*
Primary Doctor:
*
Additional Information:
Assumption of Risk
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I hereby agree that I will hold harmless Kansas City Gymnastics School and its instructors for any accident occurring in the gymnasium.
I've read the above and agree.
Medical Emergencies
(Show-Hide Details)
In the event that my child becomes ill or injured and requires medical attention, the present gym supervisor of the Kansas City Gymnastics School has my permission to have him/her treated if I can not be contacted.
I've read the above and agree.
Enter your Full Name:
*
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Address Line 1:
Address Line 2:
City:
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CT
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DE
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GA
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IA
ID
IL
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KS
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LA
MA
MD
ME
MI
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MO
MS
MT
NC
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NE
NH
NJ
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OR
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Zip:
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