JW Tumbles of Hillsdale Online Registration

Registration

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Another Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Payment Information

Please provide credit card information if you are enrolling in a class at this time.

For Monthly class enrollment: Monthly tuition includes 1 class per week and unlimited weekday open gym. 2nd class is 50% off and Sibling is 50% off.

If you are signing up for a class as a new member you will also be charged a $50 one time family membership fee. Once you are a member you can take advantage of member discounts for open gym, camps, birthday parties, and other events.

I've read the above and agree.

Signature Text

I hereby give my consent for my child's participation in the activities of JW Tumbles Children's Gym and hereby absolve and release JW Tumbles from any and all liability or damages that may be incurred by my child in the activities sponsored by JW Tumbles. JW Tumbles may use any photograph, videotape, slide or likeness of my child for publicity. I have read and understand the rules and regulations of JW Tumbles Children's Gym.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip