Please mail forms & checks to:  Peachtree Gymnastics, 8560 Holcomb Bridge Rd. #108  Alpharetta, GA 30022 Info:  770-640-6605.

TOTAL AMOUNT DUE_________________PR Week:_____AMOUNT ENCLOSED/AUTH TO CHARGE AT THIS TIME_________________

CLASS TITLE_____________________DAY/TIME___________________ CIRCLE:  Fall or  Winter/Spring  or Summer or 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 #_____________________________________________________SECURITY CODE________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)______________________________