JUSTHIS GYMNASTICS APPLICATION

Which class is your child participating in?
Date Class(es) Started

MonthDayYear
Date
Parent / Guardian Name

First NameLast Name
Give permission to my Child___________ to go to
_________________ place where you want your child brought incase of an emergency.
Day of the week your child has class
Name(s) of Directors, coaches, administrators you give permission to transport your child in case of an emergency. (Note: Staff may only transport child with other staff or child available)
Acceptable forms of transportation (Car, Bus, Cab, train)
Phone Number where you can be reached

Area CodePhone Number
Name of Insurance Company blanks Insurance ID # blank
Name of Insured

First NameLast Name
Name of Parent/Guardian

First NameLast Name
My child has had a physical in the last year

YesNo
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
We/I agree to Monthly automatic debits via PayPal, Zelle, and/or iClasspro by JustHis Gymnastics. I understand the pricing I've received is contingent upon monthly automatic debit. I also give permission for JustHis Gymnastics and its partners to review my credit score*

Clear
Thank you for completing your application. May Gods glory be revealed in our service.
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