Balance Gymnastics and Wellness Center Online Registration

Registration

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Welcome to Balance Gymnastics and Wellness Center! Please complete the following registration form.

* denotes required fields

Family Information

Family 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)*

Health Insurance Carrier*

Use of photos/videos of child

Contact #1

Contact #1 First Name*

Last Name *

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

Disabilites

Special Needs

Allergies

Medications

Primary Doctor*

Please click on the Search button below, then choose the class.

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

Disabilites

Special Needs

Allergies

Medications

Primary Doctor*

Please click on the Search button below, then choose the class.

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

Disabilites

Special Needs

Allergies

Medications

Primary Doctor*

Please click on the Search button below, then choose the class.

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

Disabilites

Special Needs

Allergies

Medications

Primary Doctor*

Please click on the Search button below, then choose the class.

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

Disabilites

Special Needs

Allergies

Medications

Primary Doctor*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

I hereby consent to the aforementioned person(s) participating in Balance Gymnastics and Wellness Center's training center and/or associated programs or events. I represent that, to the best of my knowledge, my child(ren) is/are qualified in good health, and in proper physical condition to participate in the Activity. I further represent and acknowledge that , should I ever believe that any of the above representations become untrue, or if I should ever believe that the Activity is not safe or is no longer safe for the chil(ren), that it will be my responsibility to immediately discontinue my child(ren)'s participation in the Activity. I recognize that potentially severe injuries, including permanent paralysis or death can occur in any activity involving height and/or motion including, gymnastics, tumbling and trampoline activities. That said, I agree to make my child(ren) aware of the possibility of injury and encourage my child(ren) to follow all safety rules and the coaches instructions. I fully understand that Balance Gymnastics and Wellness Center's staff members are not physicians or medical professionals and it may be deemed necessary by the staff to call a physician and to seek medical help. I understand that it is the express intent of Balance Gymnastics and Wellness Center to provide the safety and protection of my child(ren) in consideration for allowing my child(ren) to use facilities. I understand that it is the parents' responsibility to warn the child about the dangers of gymnastics and potential injury. I also understand that safe, professional instruction often includes hand on spotting to my child(ren)

I've read the above and agree.

Release of Liability

I hereby release Balance Gymnastics and Wellness Center, its officers, employees, teachers and coaches from all liability for any and all damages and injuries suffered by my child while under the supervision or control of Balance Gymnastics and Wellness Center. I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage which I consider adequate for my child(ren)'s protection and my protection.

I've read the above and agree.

Payment Policies

I understand that there are no prorations or refunds for missed classes and agree to follow the make up policy as stated by company policy. I also agree to pay tuition as per the tuition policy. Tuition is due the first class of the session. I understand that I may be subject to late fees if my tuition is not paid on time.

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*