Double Dutch Gymnastics Online Registration

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Welcome to Double Dutch Gymnastics! Please complete the following registration form.

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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 (Not Contact #1 or #2)

Are you a Military Family? Y/N

Current member at PellaBJJ

Currently enrolled at Dans co.

Enroll in auto pay? *

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

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Is your student a new gymnast?

Children should have tight fitting clothing on. Leotards are loved but not required.

Hair should be pulled back away from face.

children should show up no more then 10 minutes prior to dropping children off.

If child is being dropped off please insure there is a staff member inside building before leaving.

please be propt at picking your child/children up.

if running late please call or text.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Is your student a new gymnast?

Children should have tight fitting clothing on. Leotards are loved but not required.

Hair should be pulled back away from face.

children should show up no more then 10 minutes prior to dropping children off.

If child is being dropped off please insure there is a staff member inside building before leaving.

please be propt at picking your child/children up.

if running late please call or text.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Is your student a new gymnast?

Children should have tight fitting clothing on. Leotards are loved but not required.

Hair should be pulled back away from face.

children should show up no more then 10 minutes prior to dropping children off.

If child is being dropped off please insure there is a staff member inside building before leaving.

please be propt at picking your child/children up.

if running late please call or text.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Is your student a new gymnast?

Children should have tight fitting clothing on. Leotards are loved but not required.

Hair should be pulled back away from face.

children should show up no more then 10 minutes prior to dropping children off.

If child is being dropped off please insure there is a staff member inside building before leaving.

please be propt at picking your child/children up.

if running late please call or text.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Is your student a new gymnast?

Children should have tight fitting clothing on. Leotards are loved but not required.

Hair should be pulled back away from face.

children should show up no more then 10 minutes prior to dropping children off.

If child is being dropped off please insure there is a staff member inside building before leaving.

please be propt at picking your child/children up.

if running late please call or text.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

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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)

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

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I Agree to All of the Above

Questions or Concerns

Payment Information

Required Policies

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