Aspire Acrobatics Registration Form
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Gender *
Parent's First Name (Primary Contact) *
Your answer
Parent's Last Name (Primary Contact) *
Your answer
Parent's Phone Number (Primary Contact) *
Your answer
Parent's First Name (Secondary Contact)
Your answer
Parent's Last Name (Secondary Contact)
Your answer
Parent's Phone Number (Secondary Contact)
Your answer
Address *
Your answer
City *
Your answer
Province *
Postal Code *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Does Aspire Acrobatics’ staff have permission to call an ambulance in the case of an emergency if parent/guardian or emergency contacts cannot be reached? *
Doctor's First Name
Your answer
Doctor's Last Name
Your answer
Doctor's Phone Number
Your answer
Child's Allergies/Medical Concerns:
Your answer
How did you hear about us?
Referral? Who?
Your answer
Submit
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