|Gym & Learn Play School
Child's Name: ____________________________________ Nickname: _________________
Date of Birth: _________________________ Sex: M / F
Parent's Name: _____________________________________________________________
Mailing Address: ____________________________________________________________
City, St. & Zip: _____________________________________________________________
Home phone: (___) _____-________ Work: (___) _____-_______ Cell:(___) ____-______
Email address: _____________________________________________________________
|Students do not need be toilet-trained.
*** Annual Registration Fee is $35, Plus supply fee of $30 ***
Gym & Learn maintains a 1:8 teacher to student ratio (max enrolled: 16)
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.
MISSED CLASSES – There are no refunds, credits, or prorating of fees for missed days, holidays or
Requirements: A signed waiver form, registration form, current immunization record and a medical
|___ I do not wish to receive emails regarding info.
___ I do wish to receive emails regarding KNM Promotions.
___ I'm already on the list.
How did you hear about Kids N Motion? ____________________ Is this your 1st time at KNM? YES / NO
Which days are you interested in?__________________________________________
|Circle One Location: Woodbridge or Fredericksburg