Heidi's Gymnastics Registration Form

You're braver than you believe, stronger than you seem, and smarter than you think.
- Christopher Robin (Winnie The Pooh)

* denotes a required field

Gymnast's Name		Sex		Age		Birthday
*		F M *		*		*
		F M
		F M

Assigned Class Schedule

Day(s)		Time(s)

 

Father's Name   *

Mother's Name   *

Address   *

City   *   State   *    Zip   *

Please enter in this format: 123-456-7890
Phone #    *     Phone Type   Mobile Home *

Please enter in this format: 123-456-7890
Alternate Phone #        Phone Type  Mobile Home

SMS CONSENT: By providing my mobile phone number, I authorize Heidi's Gymnastics Philippians 4:13 to send me text messages regarding classes, schedules, reminders, weather closures, and other gym-related information. Message frequency may vary. Message and data rates may apply. Reply STOP to a text message to opt out or HELP for assistance. Mobile information will not be shared with third parties or affiliates for marketing or promotional purposes.

E-mail Address   *

Facebook Profile   

 

Family Doctor   *

Any Physical Handicaps, Limitations or anything else we should know?

 

IN CASE OF EMERGENCY PLEASE GIVE NAME AND PHONE NUMBER OF A PERSON TO CONTACT IF PARENT CANNOT BE REACHED.

Emergency Contact   *

Please enter in this format: 123-456-7890
Emergency Phone #    *

 

How did you hear about us?   

 

Parent's Name/Electronic Signature   *       *

I understand that this Registration Form may be delivered electronically. By clicking 'Submit', I acknowledge and agree that my electronic signature is legally binding and equivalent to my manual, handwritten signature. I am authorized to sign this agreement, and I affirm that my electronic signature was executed by myself with full knowledge and intent.

 

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