Summer Camp Registration (2020) July 20th-23rd Time: 9AM - 12PM Cost: $80 Is your child currently enrolled in a class at Elite Gym?*SelectYesNoMember FormChild's Name* First Last Child's Age*Parent's Name* First Last Email* Phone*Any health problems?*SelectYesNoPlease explain.Any allergies?*SelectYesNoPlease explain.Non-Member FormChild's Name* First Last Child's Age*Birthdate*Grade*Email* Phone*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Name* First Last EmployerCell Phone NumberWork Phone NumberFather's Name* First Last EmployerWork Phone NumberCell Phone NumberEmergency Contact 1* First Last Relationship*Phone Number*Emergency Contact 1* First Last Relationship*Phone Number*Any health problems?*SelectYesNoPlease explain.Any allergies?*SelectYesNoPlease explain.ReleaseI hereby authorize Elite School LLC to act for me according to their best judgement in any emergency requiring medical attention. The undersigned hereby acknowledges that participation in recreational programs involves inherent risk of physical injury, catastrophic injury, or even death. The undersigned assumes all such risks and agrees to waive and release Elite School LLC, its owners, employees, and affiliates from any liability for injuries or death incurred while involved in a program on or off the premises. The undersigned also assumes all medical costs incurred as a result of such an accident. This waiver is also applicable to any transportation in the Elite vans. Please type the following. This will serve as your digital signature.Your Name* First Last Guardian For* First Last Date* MM slash DD slash YYYY Initial - I give permission to Elite Gym to use pictures of my child to post on the Elite Facebook page and Website.*NotesPaymentPayment due in full at the time of registration. NO REFUNDS. After submitting, please call the gym to make payment.Gymnastics CampTotal $0.00 Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name Notes/CommentsCAPTCHA Δ
