Rising Star Gymnastics, Inc. Online Registration

Registration

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Welcome to Rising Star's online class registration. Please provide your information below and click submit when complete. Credit cards are NOT charged at this time. All enrollments are considered pending until we have reviewed your registration and posted any fees due. Applicable pro-rated fees are applied at that time as well. Class tuition will be pro-rated based on the number of weeks you will attend. You will receive an emailed receipt as soon as your credit card has been processed.

* 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

Type of Insurance: Employer/Individual/Government/Medicaid/Medicare/Tricare*

Insurance Company*

Policy Number*

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*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Special Needs*

Medications (Leave blank if NONE)

Automatic fees due immediately that will be posted to your account, include tuition + Yearly Membership/Insurance fee $60.00 (per child), limit $150/per family. This Yearly Membership/Insurance fee is due every year on the anniversary month of your enrollment. If your child leaves during this time for any reason, it will remain on your account until the year is complete, and you will not have to pay it again if re-registering DURING that year period.

The YMF fee ($60.00) applies to classes only, not camps. They system will post the fee and we will remove it before processing your card.

**DO NOT PROCESS YOUR CARD - WE WILL PROCESS IT WHEN WE HAVE REVIEWED AND EDITED AL FEES!!**

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Special Needs*

Medications (Leave blank if NONE)

The YMF fee ($60.00) applies to classes only, not camps. They system will post the fee and we will remove it before processing your card.

**DO NOT PROCESS YOUR CARD - WE WILL PROCESS IT WHEN WE HAVE REVIEWED AND EDITED AL FEES!!**

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Special Needs*

Medications (Leave blank if NONE)

The YMF fee ($60.00) applies to classes only, not camps. They system will post the fee and we will remove it before processing your card.

**DO NOT PROCESS YOUR CARD - WE WILL PROCESS IT WHEN WE HAVE REVIEWED AND EDITED AL FEES!!**

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Special Needs*

Medications (Leave blank if NONE)

The YMF fee ($60.00) applies to classes only, not camps. They system will post the fee and we will remove it before processing your card.

**DO NOT PROCESS YOUR CARD - WE WILL PROCESS IT WHEN WE HAVE REVIEWED AND EDITED AL FEES!!**

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Special Needs*

Medications (Leave blank if NONE)

The YMF fee ($60.00) applies to classes only, not camps. They system will post the fee and we will remove it before processing your card.

**DO NOT PROCESS YOUR CARD - WE WILL PROCESS IT WHEN WE HAVE REVIEWED AND EDITED AL FEES!!**

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?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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)