How did you hear about Kids N Motion? ____________________  Is this your 1st time at KNM?  YES / NO
Gym Class Registration Form
Date/Time _______________
Child's Name: _____________________________ Date of Birth: _____________________  

Child's Name: _____________________________ Date of Birth: _____________________  

Child's Name: _____________________________ Date of Birth: _____________________  

Parent's Name: _____________________________________________________________

Mailing Address: ____________________________________________________________

City, St. & Zip: _____________________________________________________________

Home phone: (___) _____-________ Work: (___) _____-_______
 Cell:(___) ____-______

Allergies: __________________________________________________________________

Email address: ________________________________________
If you would like to receive emails.
                                 POLICIES & PROCEDURES

CHILD’S SAFETY:
•        No shoes are to be worn on the gym floor; no exceptions.
•        Please dress your child for a gym class; no dresses.
•        Parents or guardian must remain in the gym at all times.
•        I understand I am responsible for my child’s behavior and safety while on the Kids N Motion, Inc. premises,
including parking lots, bathrooms, waiting areas, etc.

TUITION:  I understand tuition is due the first class of the session.  I know there will be a $25.00 charge for all NSF
checks.

REGISTRATION FEE:   No annual registration fee.

REQUIREMENTS:  A signed waiver form and this registration form.

MISSED CLASSES:  There are no refunds, credits, or prorating of fees for missed days, holidays or class
withdrawal. TWO MISSED CLASSES CAN BE MADE UP WITHIN THE SAME 8 WEEK SESSION. I DO NEED TO CALL
BEFORE MAKING UP A MISSED CLASS.  IF YOUR CLASS FALLS ON A HOLIDAY PLEASE SCHEDULE A MAKEUP
CLASS.  If you know you will be away during the class I will prorate the class out of the cost for the 8 weeks.

IS IT OKAY TO USE PHOTOS WE MAY TAKE DURING CLASS IN NEWSPAPERS, ETC?  
YES  /   NO  (Circle one)
3310 Noble Pond Way #101, Woodbridge, VA 22193  703-878--0100 - lbradshaw05@comcast.net