2008-2009

REGISTRATION FORM

FOR OFFICE USE ONLY

P/S 1_______2_______3_______ REC 1_______2_______

FOR OFFICE USE ONLY

FULL PAYMENT MUST ACCOMPANY THIS FORM.  ALL FEES ARE NON-REFUNDABLE.

Registration may be done either by FAX 203-977-7898 with MC/VISA,

or by mail with payment enclosed by check or MC/VISA sent to:

ARENA GYMNASTICS—P.O. BOX 4665—STAMFORD CT 06907

ADDITIONAL REQUIREMENT:

Registration will not be accepted without full completion of the  “Agreement” located on  Registration Page 2.  Please read, complete, and sign.  BOTH PAGES MUST be in our hands prior to the start of class in order for your child to participate.  Thank you.

 

Child’s Name____________________________________________M/F______

 

 

Age______Date of Birth________________Home Ph______________________

 

 

Address__________________________________________________________

 

 

Cty_________________________________State_____Zip Code_____________

 

 

Full name of Parent/Guardian__________________________________________

 

 

Cell #___________________________  Work #___________________________

 

 

Email_____________________________________________________________

 

 

In emergency, call: (name)____________________________________________

 

Hm________________________ Cell_____________________________

 

Is there anything we should know about your child, medically or otherwise?

 

_________________________________________________________________

 

 

Class Desired:  Day__________________________Time___________________

 

_____Check or money order enclosed  _____Please charge my credit card as below

 

MC/VISA________________________________________________Exp. _______

 

C.V.V. Code (last 3 digits on back of card) _________________________

 

Name of Cardholder___________________________________________________