Quest Gymnastics and Extreme Sports Center Online Registration

Registration

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Quest Gymnastics & Extreme Sports Center Class Registration Form 3820 Kemp Road Beavercreek, OH 45431 (937) 426-3547

* 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

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor

To register for a class, type in class name and hit Search. Once the classes are displayed, find the correct day and time for your class. ***EXTREME NINJA ENROLLMENTS, PLEASE STOP BY OUR OFFICE BEFORE YOUR FIRST CLASS TO BUY YOUR T-SHIRT. IT IS REQUIRED FOR UNIFORM***

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Grade Level

Disabilites

Special Needs

Allergies*

Medications*

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

Participants in physical activities can involve motion, rotation, and height in a unique environment and as such carries with it a certain assumption of risk. The undersigned, their relatives, friends, agents and the participant(s) choose to voluntarily enter upon said premises under the control of said corporation, knowing their present condition and knowing that said condition may become more hazardous and dangerous during the time the participant(s) or the undersigned, their relatives, friends and agents is on said premises. The undersigned, participant(s), all relatives, friends and agents voluntarily assume and all risks of loss, damage, injury or death that may be sustained by the participant(s), the undersigned or any other property owner by them while on the premises of Quest Gymnastics & Extreme Sports Center. The said premise may but is not obligated to carry insurance on the participant(s), and the existence of insurance shall not change, alter, or increase the liability of the corporation to the participant, their relatives, friends, and agents of affect the terms of this Release. In signing this Release the undersigned has and agreed: They he/she has thoroughly read and understands completely the terms of the Registration and Release and voluntarily signs it. Also, that he/she is the true Parent or Legal Guardian and has the consent of the participant