


Summer School Gymnastics
Student's Name _______________________Mother's Name____________________________
Student's Age ______DOB _______________Grade in Fall______School System_________
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Mailing Address: Street _____________________________City_________________Zip________
Email Address (parent or student) __________________________________________________
Home Phone # ___________Cell Phone# ________________other_______________
Please list any day or time that might be a conflict: ________________________________
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Interested in: (please mark one of the following)
1 hour Gymnastics (age 5 and up) ____________
30 minute Tumble Bugs (age 3-4) ____________