Class Registration Form

MOCO Class Registration 

Welcome! We’re excited for your child to join us for movement-based classes that build confidence, coordination, and skills through play.

Class Schedule: https://www.mocomc.com/classschedule
Please complete this form and submit payment to request a spot. A signed waiver is required.

Current Class Offerings

Tiny Tumblers (Ages 2–3): Monday & Wednesday @ 9:15 AM
Tumbling Tots (Ages 3–4): Monday @ 10:15 AM
$280 • 8-Week Session
Early Enrollment (by March 4): $224 — Save $56
March 2–April 29; (No class March 16)

JumpStart Gymnastics (Ages 4–6)
$200 • 5 weeks
March 2–April 6 (No class March 16)

Skill Builders: Build It
$360 • 8 weeks
Tuesdays @ 5 PM
March 17–May 12 (No class week of March 30)

Skill Builders: Recess Ready
$360 • 8 weeks
Thursdays @ 5 PM
March 19–May 14 (No class week of March 30)

Private Sessions
Contact us for availability.

Important Notes

Spots are limited. A child’s spot is not reserved until payment is received.

All classes are designed for independent participation unless otherwise noted.

Questions? Email classes@mocomc.com — we’re happy to help! 

Sign in to Google to save your progress. Learn more
Parent/Guardian Full Name *
Parent/Guardian Email Address: *
Parent Phone Number *
Street Address *
What is your postal or zip code? *

Photo/Video Waiver:

I, the undersigned, hereby grant permission to MOCO Movement Center to take photographs and/or videos of me during the aforementioned event/occasion.

I understand that these photographs and/or videos may be used for various purposes, including but not limited to:

Social media platforms
Website content
Educational purposes.

I agree that MOCO Movement Center owns the copyright to these photographs and/or videos and has the right to use, publish, and distribute the same in print and/or electronically. I waive any right to inspect or approve the finished product where my likeness appears.

I understand that my name may be associated with the photographs and/or videos when used for the purposes listed above.

I release MOCO Movement Center and any third parties acting under MOCO Movement Center authority from any claims, demands, or causes of action arising out of the use of the photographs and/or videos, including, but not limited to, defamation, privacy, or copyright claims.

I acknowledge that I am at least 18 years of age, or that I am the legal guardian of the individual(s) named below who are under 18 years of age, and I have read and understood the terms of this release.

 *
Child #1 Name *
Child #1 Birthdate *
MM
/
DD
/
YYYY
Does your child have any medical concerns? *
Child #2 Name
Child #2 Birthdate
MM
/
DD
/
YYYY
Does your child have any medical concerns? *
Emergency Contact - Full Name *
Emergency Contact - Cellphone Number *
Programs & Classes 
Request a Trial Class
Trials are offered for Monday Jumpstart Gymnastics or Tumbling classes only. After submitting this form, our team will contact you to confirm your trial date.
 *
Required
How did you hear about us? *
Required
MOCO Movement Center Waiver:
I fully understand that Montgomery Pediatric Physical Therapy Center LLC (“MOCO”)staff members are not physicians or medical practitioners. With the above in mind, I hereby release MOCO staff to tender temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the MOCO staff, to call your child’s physician or to seek medical help, including transportation, to any health care facility or hospital, by calling an ambulance for said child should MOCO staff deem this to be necessary. We, the staff of MOCO, recognize our obligations to make our students and their parents aware of the risks and hazards associated with sports (rock climbing, trampolines, ice skating, etc.). Students may suffer injuries, possibly minor, serious, or catastrophic in nature. MOCO and its staff members will not accept responsibility for injuries sustained by any student during the course of sports instruction in-person or online. With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by MOCO in-person and online. I, my executors or other representatives, waive and release all rights and claim for damages that I or my child may have against MOCO and or its representatives whether paid or volunteer. I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for both my child's protection of my own protection. Please insert your name below as your acknowledgement and acceptance of this waiver: *
I would like to register for a multi-week class session at this time. *
I understand that I am registering my child for a multi-week session of classes,  if I cannot attend all classes, my child is allowed one make-up class per registration, permitting space is available.  *
Please make payment prior to your first class, You are NOT registered for the class until payment is received.  Pay Here  & press submit below.    *

Join our COCO Around MOCO newsletter!
Our weekly family newsletter features class updates, therapist tips, easy at-home activities, and local adventures around Montgomery County — all in one place.

* you can opt out anytime

Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of MOCO Movement Center.

Does this form look suspicious? Report

Google Forms