GYMTEX Registration Form

fill out this form and submit it.

Child Information Child's First Name(required):

Child's Last Name(required):


Male Female

Parent Contact Info Parent's Full Name(required):




Fill in applicable contact numbers (at least one):

Telephone (home)

Telephone (work)

Telephone (Cell)


Emergency Contact Info   Emergency Contact Name (required):

Emergency Phone(required):

Doctor's Name:

Doctor's Phone:

Health Insurance Carrier:

Policy #:

Insurance Phone:


Class Sign Up Info Program Type this registration is for (Classes, Camp, Field Trip, Birthday Party, Kids Day/Night Out (required)

Day of the Week:


for the schedule, see here: class schedule

If you are not taking a class, please fill both of the following with the date that your child is participating at GYMTEX, for whatever program.

Start Date of Classes:

End Date of Classes:
Payment Options

Check Cash Credit Card

Payment by Check:

Payment by Cash:

Payment by Credit Card:

By submitting this form, you agree to this Policy: