Aerials Fit and Fun Gymnastics Online Registration

Registration

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Please note, WE WILL NOT CHARGE YOUR CREDIT CARD UNTIL we verify that the correct tuition was chosen and the class choice still has space or is running. We will also apply the appropriate class, registration fee and sibling discounts as required, the program does not do preform this function. If there are any problems with your registration we will contact you, if not you can expect to see your tuition charged within 1-3 business days.

* 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*

Home or Primary Phone*

Additional Info

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Medications

Primary Doctor

USAG Member #

If you do not see the class you want you can call or email use and we will help you right away.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Medications

Primary Doctor

USAG Member #

If you do not see the class you want you can call or email use and we will help you right away.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Medications

Primary Doctor

USAG Member #

If you do not see the class you want you can call or email use and we will help you right away.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Medications

Primary Doctor

USAG Member #

If you do not see the class you want you can call or email use and we will help you right away.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Medications

Primary Doctor

USAG Member #

If you do not see the class you want you can call or email use and we will help you right away.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

WAIVER OF LIABILITY

In consideration for my or my child(ren)s participation I hereby, for myself and my child(ren) and our respective heirs and successors, PROMISE NOT TO SUE and FOREVER RELEASE Aerials Fit n Fun Gymnastics Center L.P., Gateway Gymnastics Inc., their respective officers, directors, shareholders, employees, contractors and volunteers from all liability resulting from damages or injuries incurred as a result of participation including those resulting from acts of negligence.

I've read the above and agree.

ASSUMPTION OF RISK

I recognize that severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion, those activities including but not limited to gymnastics, tumbling, trampoline, martial arts, dance, cheerleading, ball sports, swimming and diving. In addition I recognize that swimming or any activity in or around water can result in brain damage or drowning. I am also aware that participation in certain activities including but not limited to day camps involves transportation to and from field trips and such transportation could cause injury or death in a vehicular accident. Being fully aware of these dangers, I hereby give consent for my child(ren) to participate in any and all Aerials Fit n Fun Gymnastics Center L.P., Gateway Gymnastics Inc., and affiliated entities programs and activities and I ACCEPT ALL RISKS associated with such participation.

I've read the above and agree.

MEDICAL AUTHORIZATION

In the event of an accident or emergency I hereby authorize my child(ren) to be transported to a hospital for medical treatment and I hold Aerials Fit n Fun Gymnastics Center, Gateway Gymnastics Inc., and their representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by myself or my child(ren) as a result of any injury sustained while participating at or for Aerials Fit n Fun Gymnastics Center L.P., Gateway Gymnastics Inc.,

I've read the above and agree.

PHOTO RELEASE

I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for my or my child(ren) participation I hereby grant my permission for my child(ren) likeness to be used in Aerials Fit n Fun Gymnastics Center L.P., Gateway Gymnastics Inc., publicity or advertising.

I've read the above and agree.

PARENT/GUARDIAN SIGNATURE

I understand that by accepting these terms this will serve as my electronic signature. I agree to abide by all policies and rules set forth by Aerials Fit n Fun Gymnastics. I understand that our enrollment can be revoked at any time for non-payment of fees or non-compliance of gym rules and or policies.

I have read and understand the above WAIVER OF LIABILITY, ASSUMPTION OF RISK, MEDICAL AUTHORIZATION and PHOTO RELEASE. In addition, I confirm that I am the parent/legal guardian of this registrant(s).

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

Membership Type*

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*