Rebounders Gymnastics Online Registration

Registration

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REBOUNDERS GYMNASTICS ONLINE REGISTRATION FORM

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Child's Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Parent or Legal Guardian First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Other Contact Person First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Name of School*

Medical, psychological, behavioral conditions, or dietary restrictions?

Allergies and/or Medications (Leave blank if NONE)

Medications

Date of Trial Class- $35.00

Desired Start Date for classes*

Notes

Enrollment into an open class is available for an immediate start date within 10 days. Student enrollments received in currently Open Classes with a desired start date that is more than 10 days in the future will be placed on the waiting list.

Please click on the Register Link

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Name of School*

Medical, psychological, behavioral conditions, or dietary restrictions?

Allergies and/or Medications (Leave blank if NONE)

Medications

Date of Trial Class- $35.00

Desired Start Date for classes*

Notes

Please click on the Register Link

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Name of School*

Medical, psychological, behavioral conditions, or dietary restrictions?

Allergies and/or Medications (Leave blank if NONE)

Medications

Date of Trial Class- $35.00

Desired Start Date for classes*

Notes

Please click on the Register Link

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Name of School*

Medical, psychological, behavioral conditions, or dietary restrictions?

Allergies and/or Medications (Leave blank if NONE)

Medications

Date of Trial Class- $35.00

Desired Start Date for classes*

Notes

Please click on the Register Link

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Name of School*

Medical, psychological, behavioral conditions, or dietary restrictions?

Allergies and/or Medications (Leave blank if NONE)

Medications

Date of Trial Class- $35.00

Desired Start Date for classes*

Notes

Please click on the Register Link

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

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*

Registration

Referral Information

Family Information

Where do you live?

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

Credit Card

Required Policies

(Show-Hide Details)