Gymsport Athletic Center Online Registration

Registration

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Thank you for using our online registration! If you have any questions or need any help, please call us at 412-220-1195. Adults registering should enter their own information as "Contact 1" AND "Student". Your privacy is important to us. We will not sell or abuse your contact information. Email addresses for family contacts will be added to the Gymsport mailing list. You can unsubscribe from this list at any time.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family (Last Name) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (After Parents)*

Contact #1

Parent/Guardian #1 First Name*

Last Name *

Type*

How Can We Contact You?

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

Parent/Guardian #2 First Name

Last Name

Type

How can we contact you?

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

T-Shirt Size

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Medications (Leave blank if none)

Please note that anyone who wishes to register for an intermediate or advanced class in any program must first be evaluated or have previous class experience at Gymsport.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Medications (Leave blank if none)

Please note that anyone who wishes to register for an intermediate or advanced class in any program must first be evaluated or have previous class experience at Gymsport.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Medications (Leave blank if none)

Please note that anyone who wishes to register for an intermediate or advanced class in any program must first be evaluated or have previous class experience at Gymsport.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Medications (Leave blank if none)

Please note that anyone who wishes to register for an intermediate or advanced class in any program must first be evaluated or have previous class experience at Gymsport.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Special Needs (Leave blank if none)

Allergies (Leave blank if none)

Medications (Leave blank if none)

Please note that anyone who wishes to register for an intermediate or advanced class in any program must first be evaluated or have previous class experience at Gymsport.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Automatic Payment Schedule*

Please fill out CREDIT CARD Payment Method

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*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)