Registration
Already a customer? Click here to login.
Viking Gymnastics & Dance
*
denotes required fields
Referral Information
How did you hear about us?
*
Listings Website (eg yelp.com)
Local News Website (eg Patch, Triblocal)
Other
Referral
School flyer/Brochure
Social Media site (eg Facebook)
Referral Name
*
Family Information
Family Last Name
*
Where do you live?
Home 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
PR
VI
Zip
*
Primary Phone
*
Additional Info
Emergency Contact Info
Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
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
Contact #2
Contact #2 First Name
Last Name
Type
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
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
*
Female
Male
Birth Date
*
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Adult XX-Large
Child Large
Child Medium
Child Small
Child X-Small
School
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Allergies (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Adult XX-Large
Child Large
Child Medium
Child Small
Child X-Small
School
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Allergies (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Adult XX-Large
Child Large
Child Medium
Child Small
Child X-Small
School
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Allergies (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Adult XX-Large
Child Large
Child Medium
Child Small
Child X-Small
School
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Allergies (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
Additional Info
Student Email
T-Shirt Size
Adult Large
Adult Medium
Adult Small
Adult X-Large
Adult XX-Large
Child Large
Child Medium
Child Small
Child X-Small
School
Grade Level
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Allergies (Leave blank if NONE)
Add Another Student
Required Policies
(Show-Hide Details)
I Agree to All of the Above
Enter your Full Name
*
November 21, 2024
Questions or Concerns
Comments
Payment Information
Credit Card
Card Number
Visa
Mastercard
Discover
Exp Month
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year
Card Nickname
Name as it appears on card
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
