MY GYM Children's Fitness Center

BIRTHDAY PARTY RESERVATION REQUEST

You have selected 3/28/2010, from 4-6 PM for your Celebration.
Please complete the following form to reserve the selected party date and time. We will contact you to confirm your reservation. A $100 non-refundable deposit will be required at that time to secure your reservation.

Parent or Guardian Information: Please fill out the information below:

Member of My Gym?

No Yes

If your child or his/her sibling are now or have ever been enrolled in My Gym classes at the Buffalo Grove or any other My Gym location, then you are Members. Please answer "Yes".

Your First Name:

Your Last Name:

Your Street Address:

City, State, Zip Code:

Your Email Address:

Home Phone Number:

Cell Phone Number:

Notes / Comments/
Best time and preferred
method of reaching you:

Birthday Child Information:

First Name:

Date of Birth: