Chantilly Academy Gymnastics Online Registration

Registration

Already a customer? Click here to login.

Welcome to Chantilly Academy Gymnastics & Preschool. Our CA kids are Active....Happy...Strong...Together! Thank you for completing your Annual Online Registration & Release Form, required prior to participation taking place.

* 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*

Primary Phone*

Additional Info

Emergency Contact Information (other than parents)*

Health Insurance Carrier & Policy Number*

Contact #1

Mother's First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Chantilly Academy Gymnastics. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Father's First Name*

Last Name*

Type

How can we contact you?

Home Phone

Work #

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Chantilly Academy Gymnastics. Standard message and data rates apply. Reply STOP to opt out

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation

Allergies/Previous Injuries*

Medications*

Primary Doctor & Phone Number*

Be sure to visit our website: www.chantillyacademy.com for more details. With the utmost safety of our students & staff in mind we ask that you review our required Wellness Protocols online which includes contactless temperature screening & questionnaire, drop off/pick up at door only, easy to remove footwear & a required drawstring bag for all belongings brought into gym. Be sure to sign up for our CCTV App SPOT/TV to watch your favorite gymnast in class or practice.

Please contact CA's main office for any additional information or assistance you may need at info@chantillyacademy.com or call us at 703-378-4966. Thank You!

CA Kids are Active...Happy...Strong...Together!

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation

Allergies/Previous Injuries*

Medications*

Primary Doctor & Phone Number*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation

Allergies/Previous Injuries*

Medications*

Primary Doctor & Phone Number*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation

Allergies/Previous Injuries*

Medications*

Primary Doctor & Phone Number*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Transportation

Allergies/Previous Injuries*

Medications*

Primary Doctor & Phone Number*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Auto Pay*

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*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

(Show-Hide Details)