Triad Kids Campus Online Registration

Registration

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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*

Home or 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* (format=mm/dd/yyyy)

Additional Info

School

Grade Level

Allergies

Medications

Primary Doctor

If you need to register for an 'invitation only' class, please call or stop by our front desk. Thank you.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School

Grade Level

Allergies

Medications

Primary Doctor

If you need to register for an 'invitation only' class, please call or stop by our front desk. Thank you.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School

Grade Level

Allergies

Medications

Primary Doctor

If you need to register for an 'invitation only' class, please call or stop by our front desk. Thank you.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School

Grade Level

Allergies

Medications

Primary Doctor

If you need to register for an 'invitation only' class, please call or stop by our front desk. Thank you.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

School

Grade Level

Allergies

Medications

Primary Doctor

If you need to register for an 'invitation only' class, please call or stop by our front desk. Thank you.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

Please read, sign and bring waiver to the front desk. Children without waiver signed will not be able to participate.
My/Our child/children has/have no physical conditions that would limit his or her participation in athletic activities. I/We hereby give permission for my/our child/children to participate in activities at IA KIDS, LLC, dba Triad Gymnastics, and to work on all of the necessary equipment. I/We assume all risks and hazards incidental to the conduct of this activity and transportation to and from this activity. In case of emergency, the IA KIDS, LLC, dba Triad Gymnastics, staff has my/our permission to use their judgment with regard to treatment until I/we can be contacted. Moreover, I/we hereby authorize any qualified physician contacted to proceed with treatment. In case of emergency, I/we understand that my/our child/children will be transported to the nearest hospital OR (preferred hospital):____________________________________________________ by the local emergency resource if rescue squad deems necessary. I/We understand that I/we will be responsible for all medical and emergency transportation expenses. It is understood that in some medical situations, the staff will need to contact the emergency resources before contacting the parent or other adult acting on the parents' behalf. Warning.... Catastrophic injury, paralysis, or death can result from improper conduct of this activity.

I've read the above and agree.

Permission to Photograph

Occasionally IA KIDS, LLC, dba Triad Gymnastics, will take photos for advertising or informational purposes. I/We hereby give IA KIDS, LLC, dba Triad Gymnastics, permission to use my child's/children's photos and likeness in all forms and media for advertising, portfolio, demo, trade, stock photography, editorial, altering without restrictions, and all other lawful purposes. I/We understand I/We are entitled to no compensation. I/We release the photographer all forms of claims and liability related to my photo usage.
(This Policy Subject To Change Without Notice)

I've read the above and agree.

Payment Policies

Tuition is due on the 1st of the month. If payment is not received by the 20th of the month, you could be removed from class and a late fee may be assessed. We do require a credit card on file for monthly auto debit/credit. Payment may be made prior to the 1st of the month by other methods.
Registration fees and tuition are non-refundable. Notice must be made by the 25th of the month for the next month if dropping a class, otherwise you will be responsible for the next month's tuition.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

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