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Hello and welcome to Gravity Athletics Sports Facility • East Texas Athletics LLC.

* denotes required fields

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 (Not Contact #1 or #2)*

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?

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*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Immunization Notes

If you have any questions about classes please feel free to contact us at

Gravity Athletics Sports Facility 903.368.9554 or gravityathleticsvbc@gmail.com

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Immunization Notes

If you have any questions about classes please feel free to contact us at

Gravity Athletics Sports Facility 903.368.9554 or gravityathleticsvbc@gmail.com

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Immunization Notes

If you have any questions about classes please feel free to contact us at

Gravity Athletics Sports Facility 903.368.9554 or gravityathleticsvbc@gmail.com

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Immunization Notes

If you have any questions about classes please feel free to contact us at

Gravity Athletics Sports Facility 903.368.9554 or gravityathleticsvbc@gmail.com

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Immunization Notes

If you have any questions about classes please feel free to contact us at

Gravity Athletics Sports Facility 903.368.9554 or gravityathleticsvbc@gmail.com

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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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

Required Policies

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