Please mail forms & checks to:  Peachtree Gymnastics, 3872 Roswell Rd. #4, Atlanta, GA  30342.   Info:  404-257-9912.

TOTAL AMOUNT DUE______________AMOUNT ENCLOSED OR AUTHORIZED TO CHARGE AT THIS TIME______________________

CLASS TITLE__________________________DAY/TIME____________________ CIRCLE:  Fall, Winter/Spring , Summer, Entire School Yr

CHILD’S NAME_______________________________________________GENDER_________BIRTHDATE________________Age_______

ADDRESS_____________________________________________________________CITY____________________ZIP_________________

PARENT’S NAME____________________________PHONE #___________________________CELL  #_____________________________

CIRCLE:  Current student, Former student or New           T-SHIRT (Optional $10, Add to total cost)  SIZE:  (2-4), (6-8), (10-12), (14-16), AS, AM

VISA OR MC #______________________________________________________________________EXP DATE_______________________

In an event of an emergency involving my child, and if Peachtree Gymnastics cannot get in touch with me, I hereby authorize any needed emergency medical care.  I further agree to be fully  responsible for all medical expenses incurred during the treatment of my child.

Signature of Parent or Guardian_____________________________________E-mail Address(IMPORTANT)_______________________________