Georgia All-Star Gymnastics Online Registration

Registration

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To sign-up for a FREE trial class or any event, please complete this form, including a valid form of payment. Don't worry, we don't charge you anything until you decide to enroll. Once your trial class has concluded please speak with your athlete's Coach & the front desk & let us know if you would like to keep their spot in the class. Please be sure that your address on file matches your billing address. We look forward to meeting you! :)

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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*

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

T-Shirt Size

School

Grade Level

Who Transports to/from Class

Disabilities

Special Needs

Allergies*

Medications*

Primary Doctor*

Immunizations YN

Immunization Notes

Dentist/Orthodontist

Previous Injuries

Glasses or Contacts?

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

School

Grade Level

Who Transports to/from Class

Disabilities

Special Needs

Allergies*

Medications*

Primary Doctor*

Immunizations YN

Immunization Notes

Dentist/Orthodontist

Previous Injuries

Glasses or Contacts?

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

School

Grade Level

Who Transports to/from Class

Disabilities

Special Needs

Allergies*

Medications*

Primary Doctor*

Immunizations YN

Immunization Notes

Dentist/Orthodontist

Previous Injuries

Glasses or Contacts?

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

School

Grade Level

Who Transports to/from Class

Disabilities

Special Needs

Allergies*

Medications*

Primary Doctor*

Immunizations YN

Immunization Notes

Dentist/Orthodontist

Previous Injuries

Glasses or Contacts?

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

School

Grade Level

Who Transports to/from Class

Disabilities

Special Needs

Allergies*

Medications*

Primary Doctor*

Immunizations YN

Immunization Notes

Dentist/Orthodontist

Previous Injuries

Glasses or Contacts?

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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Questions or Concerns

Payment Information

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Required Policies

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