Registration

Parent's Night Out Event: From 7:00PM-11:00PM. (4 hours or any portion of that time) Activities includes 1 hour of fun class, 1 hour of games and group recreation activities, drinks and snacks, board games, arts and craft and supervised free time. Price: $25.00 flat fee/child Ages: 3 years-12 years
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Please add any special instructions here:
 
Additional Information:
 
Release of Liability
As the legal parent or guardian, I release and hold harmless GYMNASTICS WORLD, LLC, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of GYMNASTICS WORLD, LLC, its owners and operators or in route to or from any of said premises.
I've read the above and agree.
 
Medical Emergency
The undersigned gives permission to GYMNASTICS WORLD,LLC, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician ________________ be called and that my child be transported to ______________________ hospital. Please include physicians' phone number _______________.
I've read the above and agree.
 
Payment Information
All fees associated to the Parents Night Out must be paid before your child is dropped at our facility on the day of the event. There is a $35.00 returned check charge for any checks returned by the bank.
Fees must be paid up front by cash, check or credit/debit card.

I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*