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| Parent First name:
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Parent Last Name:
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| Child's First Name:
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Child's Last Name:
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| Child's Birth date/Age:
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Child's Nick Name:
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| Contact Information |
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| Home Phone:
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Work Phone:
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| Home Address:
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Home City:
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| Home State:
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Home Zip:
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| Cell Phone:
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Email:
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| Emergency Contact:
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Emergency Contact Phone:
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| Camp Information |
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type:
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Select Day of Week:
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Select Weeks: |
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| Payment Information, please enclose
check payable to: Flip Over Gymnastics |
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| Amount: | * No Refunds, * Insurance INCLUDED | ||
| Referred by:
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Relation:
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| Parent Signature:
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Date:
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| Comments: |
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By signing this form I understand & agree to all rules, regulations and terms set forth in the Flip-Over Contract. Once you sign up your child for a class you will be responsible for completing: Flip Over Rules and Regulations form and a Release Form.