Registration
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Will-Moor Gymnastics and Cheer registration form:
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denotes required fields
Referral Information
How did you hear about us?
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Community Board
Local Events
Referral
Social Media
Transfer
Website
Referral Name
Family Information
Family Last Name
*
Where do you live?
Home Address
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City
*
State
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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
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Home or Primary Phone
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Additional Info
Emergency Contact Info
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Health Insurance Carrier
Date of Registrations
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Contact #1
Contact #1 First Name
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Last Name
*
Type
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Aunt/Uncle
Babysitter
Father
Grandparent
Guardian
Mother
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
Aunt/Uncle
Babysitter
Father
Grandparent
Guardian
Mother
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
*
(format=mm/dd/yyyy)
Additional Info
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=mm/dd/yyyy)
Additional Info
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=mm/dd/yyyy)
Additional Info
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=mm/dd/yyyy)
Additional Info
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
*
Female
Male
Birth Date
*
(format=mm/dd/yyyy)
Additional Info
Disabilities (Leave blank if NONE)
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Medications (Leave blank if NONE)
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
*
Questions or Concerns
Comments
Payment Information
Account Information
e-Payment Schedule
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
eCheck/Bank Draft
Bank Name
Account Type
Checking
Savings
Your Account Name
(Your name on your bank statement)
Bank Routing Number
(9-digit number)
Account Number
