Jumping Jack Sports Class/Camp Registration Form

Please fill out all fields below

Childs First and Last Name:	Childs Birthday (mm/dd/yyyy):	Childs Age:

Address:	City:	State:

Contact Email:	Phone:	School:

Mother's Name:	Contact Phone:
Father's Name:	Contact Phone:
Class/Camp of Interest:                                                                                            Halloween Fun House School Day Off SkipTastic Mega Sports Ultra Sports Fitness Frenzy Girl Power Hour FunFit		Desired Day and Time:

Are you already a register member of Jumping Jack Sports?			Yes No
Are there any siblings currently enrolled in classes at Jumping Jack Sports?			Yes No
Does the child enrolling have any health issues we should be aware of?			Yes No
If yes, please explain:

Payment is due in full in order to hold your spot in a class. Please call with 703-858-9901 with credit card information or send a check to:
Jumping Jack Sports, 44710 Cape Court #128, Ashburn, VA 20147.
You are also welcome to drop off a payment.