Multi-Gymnasts Registration Form
Email
*
example@example.com
REFERRAL INFORMATION
Billboard
Instagram
Facebook
Internet search
Website
Referral
Already a member at the gym
Referral name:
FAMILY INFORMATION
Contact information
Contact 1
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact 2
First Name
Last Name
Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
EMERGENCY CONACT
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Aunt/Uncle
Grandparents
Mom/Dad
Family Friend
Other
CHILDREN INFORMATION
Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Medical Information - Please list any disabilities, special needs, and/or allergies
*
Class day and time you signed your child up for
*
Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Medical Information - Please list any disabilities, special needs, and/or allergies
*
Class day and time you signed your child up for
*
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Gender
Female
Male
Medical Information - Please list any disabilities, special needs, and/or allergies
Class day and time you signed your child up for
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Gender
Female
Male
Medical Information - Please list any disabilities, special needs, and/or allergies
Class day and time you signed your child up for
Waiver and Policy
*
I understand that there are no refunds, credits, or makeup classes for missed classes when my child does not attend a class / is absent.
*
I understand that there are no refunds, credits, or makeup classes when programs are cancelled due to exceptional circumstances, including but not limited to severe weather, flooding, outbreaks, and any other unforeseen circumstances/emergencies that do not allow for safe operation of the facility.
*
I understand that a refund will not be issued and are subject to cancellation fees. Classes are non-refundable.
Signature
*
Date signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: