Green Bay Fusion Online Registration

Registration

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Fitness, Focus and Fun!

* denotes required fields

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)

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

Student #1

Student's First Name*

Last Name*

Student Gender*

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

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

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

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk and Release of Liability

As the parent/guardian of the child registered above, I give my permission to Fusion Athletics to act on my behalf to contact an available medical provider and herby authorize the physicians and their associates of an appropriate medical facility to perform such diagnostic, medical and/or surgical treatment on my child as may be deemed necessary in order to assure the safety of my child(ren). I fully understand that in the case of an ambulance is required; I am liable for all costs.

I also fully understand that all-star cheer, dancing, stunting, tumbling , ninja and conditioning activities may be dangerous and my son/daughter will be exposed to risk of injury. I hereby give my permission for my child(ren) to participate in the program and activities of Fusion Athletics. I release all the staff, coaches, and contractors of Fusion Athletics from any liabilities resulting from participation.
I fully understand photos and/or videos may be taken during classes, clinics or parties.. All media is the property of Fusion Athletics and we have the right to use the video or images on all social media as we see fit.

I've read the above and agree.

Payment Policy

I fully understand payment in full is due on or before the first class session, party or clinic date. A 24 hour notice is required to drop a clinic or private lesson. Without notice, the required fee for the clinic or lesson will be charged. . A $25 NSF will be charged to all returned checks. A $5 fee will be charged to all declined credit cards. Accounts not paid on the 5th of the month will no longer be allowed to participate in classes or team until the account is brought current along with a $50 late fee.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

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*