Coastal Realm Gymnastics Online Registration

Registration

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Welcome to COASTAL REALM GYMNASTICS ("CRG")! This online form is used to register, enroll, and pay for Realm classes; and establish credentials to access the PARENT PORTAL.

ANNUAL MEMBERSHIP FEE: A membership fee of $60 (per student) is due upon registration. Refer to Payment Policies for more information.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family's Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact: Please provide Full Name, Cell Phone #, and Relationship to Student*

Contact #1

Main Contact's First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Alternate Contact's First Name

Last Name

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Gender*

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

Additional Info

School

Grade Level

Social Media and Promotional Photo Release (Leave blank if AGREE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skills and Misc. Notes

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

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

Additional Info

School

Grade Level

Social Media and Promotional Photo Release (Leave blank if AGREE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skills and Misc. Notes

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

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

Additional Info

School

Grade Level

Social Media and Promotional Photo Release (Leave blank if AGREE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skills and Misc. Notes

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

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

Additional Info

School

Grade Level

Social Media and Promotional Photo Release (Leave blank if AGREE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skills and Misc. Notes

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

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

Additional Info

School

Grade Level

Social Media and Promotional Photo Release (Leave blank if AGREE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Skills and Misc. Notes

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Add Another Student

Required Policies

(Show-Hide Details)

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*

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)

Contact #2

How can we contact you?

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

Credit Card

Required Policies

(Show-Hide Details)