Bayou Gymnastics

Gymnastics Registration Form

Semester Date:	Day and Time of Class:

Child's First and Last Name:	Child's DOB:

Child's Age:	Child's Gender:

Daytime Phone:	Street Address:

City, State:	Zip Code:

Mother/Guardian Name:	Mother/Guardian Number:

Father/Guardian Name:	Father/Guardian Number:

Emergency Contact Name:	Relationship:

Contact Number 1:	Contact Number 2

Family Physician:	Phone Number:

Insurance Company:	ID Number:

Medical conditions we should be aware of:

Is your child currently enrolled in our program? If so, which one?

How did you hear about our program?

Do you permit Bayou Gymnastics to photograph/videotape your child for promotional use?		Yes No

I have read and agree to the Waiver and Release of Liability.

I agree that I have completed the above information, and it is true to the best of my knowledge. I have also read and fully understand the Waiver and Release of Liability and realize by typing my name and date in the boxes below, I have verified this information and am digitally signing this form.
Electronic Signature:	Date:

Completing this form DOES NOT guarantee your spot in the class of your choice.

*TUITION IS DUE PRIOR TO THE 1ST OF EACH MONTH
*REGISTRATION FEES ARE NON-REFUNDABLE

Payment Options
We accept Cash, Checks, and Visa, MasterCard and Discover (Credit and Debit)

You may pay monthly or for the entire semester
Make checks payable to: Bayou Gymnastics
On check, include: Child's Name, Class Day & Class Time
$25.00 Service Charge for all returned check