GYMNASIANA

 

EVERY CHILD IS A STAR AT GYMNASIANA

 
HOMECLASS SCHEDULETEAMREGISTRATIONCONTACT

HomeCLASS STRUCTURETEAMREGISTRATIONCONTACT

GYMNASIANA REGISTRATION

Name ______________________________________Phone _________________________                                              (Student's Name)

Address____________________________________________________________________                                               (Number and Street)

            ____________________________________________________________________                                              (City and Zip Code)

Date of Birth ___________________________

IMPORTANT:  FULL MONTHLY PAYMENTS MUST BE MADE ON OR BEFORE THE 10TH OF THE MONTH

STATEMENT OF LIABIALTY:

WE UNDERSTAND THE FOLLOWING: GYMNASIANA WILL NOT BE LIABLE FOR INJURIES OCURRING FROM 

PREVIOUS SICKNESS OR ACCIDENTS.

I, ___________________________, AM IN GOOD HEALTH AT THIS TIME AND HAVE NO PREVIOUS ILLNESS OR

INJURY WHICH WOULD BE AFFECTED BY PARTICIPATION IN THIS PROGRAM.

 

________________________________________                  _________________________                                               SIGNATURE OF PARENT OR GUARDIAN                                         DATE

 

MOTHER'S NAME ___________________________________                   ______________________________

                                                         (Please Print)                                                                  (Occupation)

FATHER'S NAME ____________________________________                  ______________________________

                                                         (Please Print)                                                                   (Occupation)

NAME OF INSURANCE POLICY ___________________________________

EMERGENCY TELEPHONE NUMBER ______________________________

TIME & DAY OF CLASS __________________________________________

EMAIL ________________________________________________________

_____________________________________________________________________________________________

You can mail the registration form along with a $75.00 registration fee made payable to:

Gymnasiana
12036 Industriplex Blvd.
Baton Rouge, LA 70809

For personal assistance please call at: 225-751-3517