Courthouse Gymnastics Co Online Registration

Registration

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ENTER YOUR INFORMATION BELOW AND SUBMIT. REG. FEE & TUITION are Due When you ENROLL in classes and will be Drafted Immediately or within 24 hours of enrolling. All enrollments are PENDING until we review your Registration Forms and your Fees are processed and PAID. . WHEN YOU SIGN THE ONLINE REGISTRATION FORM OR AGREE TO POLICIES WHEN YOU LOG IN YOUR ACCOUNT YOU ARE SIGNIFYING YOU HAVE READ THE RULES AND POLICIES AND THE ENROLLMENT INSTRUCTIONS.

* 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*

Primary Phone*

Additional Info

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

Health Insurance Carrier*

TuitionPayor Relation to Child*

Contact #1

1. Primary Contact Parent 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

Minimum number of characters is 5

Confirm Portal Account Password

Minimum number of characters is 5

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

2. Other Parent Contact First Name*

Last Name*

Type*

How can we contact you?

Home Phone *

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Special Needs. *

Allergies. *

Medications.*

Primary Doctor*

Immunizations YN*

Immunization Notes*

Private Lessons ONLY? Yes, No*

If YES, Instructor's Name

Students ENROLLED in MAY of Last school year received information about which Class to sign up for in the summer or the current year.
NEW students must sign up for Beginner or Preschool classes unless Evaluated by a Courthouse Instructor. Courthouse Gymnastics may Remove any child registered in the Wrong level class. We are Not Responsible if the correct class is Full.
PRIVATE LESSONS: READ the Private Lessons Rules on the Classes, Register, Enroll website or Summer page.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Special Needs. *

Allergies. *

Medications.*

Primary Doctor*

Immunizations YN*

Immunization Notes*

Private Lessons ONLY? Yes, No*

If YES, Instructor's Name

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Special Needs. *

Allergies. *

Medications.*

Primary Doctor*

Immunizations YN*

Immunization Notes*

Private Lessons ONLY? Yes, No*

If YES, Instructor's Name

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Special Needs. *

Allergies. *

Medications.*

Primary Doctor*

Immunizations YN*

Immunization Notes*

Private Lessons ONLY? Yes, No*

If YES, Instructor's Name

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

School*

Grade Level*

Disabilites*

Special Needs. *

Allergies. *

Medications.*

Primary Doctor*

Immunizations YN*

Immunization Notes*

Private Lessons ONLY? Yes, No*

If YES, Instructor's Name

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)