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Child Private / Semi Private Registration
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Child's Name
*
First
Last
Childs D.O.B
*
Child's Age
*
Gender
Male
Female
If you have a second child, you MUST complete a separation registration form for that child.
Parent/Guardian's Name
Are you an employee?
Yes
No
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Work Number
Cell Phone
Email
*
Instructor Preferance for private or semi-private lessons
Time Preference
AM
PM
An instructor will reach out to schedule a time.
Member
Private | $205
Semi-private | $290 ($145 per child)
I'm not a member
Non-Member
Private | $245
Semi-private | $330 ($165 per child)
I'm a member
How would you like to pay for the lessons (non-members must provide a credit card, representative will reach out with Credit Card Auth Form)
*
House Account **Preferred**
Check (Check must be brought in to hold spot) | Must be paid in 48 hours to hold
Credit Card | Must be paid in 48 hours to hold
Cash | Must be paid in 48 hours to hold
Payment must be made to ensure your spot
Signature
*
Clear Signature
Waiver | I accept full responsibility for my use of any apparatus, appliances, facility privileges, or service whatsoever, owned and operated by this club, directors, officers, employees, representatives, and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by myself, my family or others under my supervision or control resulting therefrom. Also, I agree that the information above is accurate and complete. I also understand and acknowledge that photos/videos may be taken for publicity/marketing purposes. I also give my authorization for any photos or video footage of myself or my minor child to be used in this fashion.
Date / Time
Date
Time
Promotional Code (Optional)
Submit