Rising Stars

This program is by request only. Please fill out the from below to send a request. Winter 2027.

Participant Name*

First

Last

Date of Birth*

day

month

year

Current Age*

Gender*

Male

Female

Special Needs

Parent / Guardian Name*

First

Last

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Home Phone*

Cell Phone

Emergency Contact Name*

Emergency Contact Phone*

Email*

Course Days*

Monday 5:00 - 6:00

Saturday 1:30 - 2:30

Request Acknowledgment*

I understand that this program is request only and would like my child to be assessed for the selected program.

Parent Waiver Agreement*

I have read and understand the Assumption of Risk Release and Waiver of Liability Indemnity Agreement, and by checking this box it will act as an electronic signature of consent.

Categories: In The Gym, Winter 2027

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