Registration
4 openings left in this event!
Already a customer? Click here to login.
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
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
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
(Show-Hide Details)
This waiver and release of liability applies to and includes High Energy Fitness & Gymnastix LLC dba Hi-NRG Gymnastix, its board of directors, officers, employees, instructors, agents, representatives, any independent contractors, including any and all instructors, landlords, and its successors as assigned.This waiver and release of liability shall not cover those situations where loss, injury or damage to the above participant is the result of the intentional and/or reckless conduct by any of the parties included in this waiver and release. The undersigned further agrees to indemnify and save and hold Hi-NRG Gymnastix harmless, including all other parties identified above from any liability arising out of negligent or intentional conduct of students, parents, family members or parties invited upon the premises by the student or any family members which results in loss, injury or damage to any other party. As parent or legal guardian of the student named above, I understand and recognize that severe injuries can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, cheerleading, acrobatics, tumbling, and trampoline. Being fully aware of these dangers, I hereby give consent for my child(ren) to participate in any and all Hi-NRG Gymnastix and affiliated entities, programs and activities and I ACCEPT ALL RISKS associated with such participation. Hi-NRG Gymnastix gives safety of the student the highest priority, employing competent, trained instructors and using the best equipment and safety aids available. If there should be an accident, we will make EVERY EFFORT to contact the child's parents FIRST. IF WE CANNOT get in touch with you, then we MUST have authorization to secure medical treatment.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
Please Wait...