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Teaching integrity and respect while increasing confidence and strength through athletics **IF YOU HAVE BEEN TO OUR GYM BEFORE, PLEASE TEXT US (818-351-2112) AS YOU MAY ALREADY HAVE A VALID WAIVER ON FILE & DO NOT NEED TO FILL OUT THIS REGISTRATION FORM**

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Parent Information

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Primary Phone*

Additional Info

In case of emergency, who should we contact if the adults listed above are unavailable*

Health Insurance Carrier, Subscriber Name, and I.D. Number

Contact #1

Contact #1 First Name*

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Home Phone

Work #

Cell # *

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Contact #2

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Work #

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Confirm Email

Student #1

Student's First Name*

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Additional Info

Student Email

T-Shirt Size

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Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

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Please note that student arriving more than 5 minutes late to their class will have to warm up and stretch on their own.

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Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 5 minutes late to their class will have to warm up and stretch on their own.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

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Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 5 minutes late to their class will have to warm up and stretch on their own.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 5 minutes late to their class will have to warm up and stretch on their own.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Previous Injuries

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor and Phone Number

Please note that student arriving more than 5 minutes late to their class will have to warm up and stretch on their own.

Enroll in Classes

Select Class *

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Referral Information

Parent Information

Where do you live?

Additional Info

Contact #1

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Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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