Exceleration Gymnastics Center Online Registration

Registration

Already a customer? Click here to login.

Welcome to Exceleration Gymnastics Center's online registration! Please provide your information below and click Submit when complete. Credit cards will be charged for the $35 registration fee & first month's tuition upon class registration. If your child is starting mid-month tuition will be prorated. If no class is selected, your card will not be charged until a class enrollment has been made.

* 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 Info*

Health Insurance Carrier*

Preferred Hospital*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

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

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

Cell # Receive Text Message Notifications

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

Disabilities (If NONE please note)*

Special Needs (If NONE please note)*

Allergies (If NONE please note)*

Medications (If NONE please note)*

Primary Doctor (If NONE please note)*

Immunization Notes

Choose any filter to narrow your search.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (If NONE please note)*

Special Needs (If NONE please note)*

Allergies (If NONE please note)*

Medications (If NONE please note)*

Primary Doctor (If NONE please note)*

Immunization Notes

Choose any filter to narrow your search.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (If NONE please note)*

Special Needs (If NONE please note)*

Allergies (If NONE please note)*

Medications (If NONE please note)*

Primary Doctor (If NONE please note)*

Immunization Notes

Choose any filter to narrow your search.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (If NONE please note)*

Special Needs (If NONE please note)*

Allergies (If NONE please note)*

Medications (If NONE please note)*

Primary Doctor (If NONE please note)*

Immunization Notes

Choose any filter to narrow your search.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (If NONE please note)*

Special Needs (If NONE please note)*

Allergies (If NONE please note)*

Medications (If NONE please note)*

Primary Doctor (If NONE please note)*

Immunization Notes

Choose any filter to narrow your search.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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

Account Information

Credit Card

Required Policies

(Show-Hide Details)