register

If you are requesting a free trial class, the Gym must contact you first to schedule a convenient time.

REGISTER

"*" indicates required fields

Parent's 1 Name*

Parent's 1 Email*

Parent's 1 Cell Phone*

Parent's 2 Name

Parent's 2 Email

Parent's 2 Cell Phone

Emergency Contact Name and Telephone*

Referred By

Address

Street Address City State ZIP Code

Child's 1 Name

Child's 1 Birthdate

Child's 1 School

Child's 1 Doctor & Tel

Child's 2 Name

Child's 2 Birthdate

Child's 2 School

Child's 2 Doctor & Tel

Child's 3 Name

Child's 3 Birthdate

Child's 3 School

Child's 3 Doctor & Tel

Message

SIGN (parent or guardian)

I hereby consent to my children’s participation in structured and supervised classes on equipment owned and/or used by STARZ, LLC, dba JUNIOR GYM and hereby agree that I, for myself, my child (children) adopted or otherwise my heirs and executors waive and release any and all rights and claims for damages that I may have at any time against STARZ, LLC, dba JUNIOR GYM or their agents and representatives, for any injury or damages in connection with my association, or entry, in activities sponsored by STARZ, LLC, dba JUNIOR GYM.
In case of emergency, I understand that the STARZ, LLC, dba JUNIOR GYM staff will attempt to notify me or the person I have designated as emergency contact. Should STARZ, LLC, dba JUNIOR GYM be unable to locate either one, I hereby grant authority to the STARZ, LLC, dba JUNIOR GYM staff to take temporary measures as they deem appropriate. I understand that STARZ, LLC, dba JUNIOR GYM is not responsible for any medical expenses.
I have read and understand the STARZ, LLC, dba JUNIOR GYM POLICIES AND PROCEDURES.
Your signature will affirm that your child is physically capable of participating in our Physical Education Program.
By entering your Name below, you are hereby agreeing to the terms above.

Full name*

Date*

Signature - Sign the form on touchscreen devices, touch pads or use your mouse.

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