Apply for Adaptive Gymnastics!

Parent's Name *Child's Name *Street Address *City, State, ZIPPhone Number *Email *Age of Student *Program of Interest *1/2 hour one on one.1/2 hour open playGroup Class one day a weekPlease tell us about your child's special needs*Are there any physical limitations that we need to be aware of? *Are there any physical activities your child should not participate in? *Please tell us anything medically that we need to be aware of? *What physical activites is your child currently participating in? *Is your child aggressive? *YesNoOther (fill out field below)Are there any triggers we should be aware of? *Why do you feel gymnastics might benefit your child? *Is there any other information you would like us to know about your child? *How did you hear about our Adaptive Gymnastics Program? *Are you interested in a partial scholarship? *YesNoIf approved, we set up lessons 3 months at a time and then we revisit the relationship and the scholarship.
It is your responsibility to keep a credit card on file.
You are required to contact the office to maintain the scholarship or we automatically move your account to a private pay.
The $25 annual membership is due before the first class regardless of scholarship status. *Yes, I understand these requirements.

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