MY GYM Children's Fitness Center

MOMMY'S MORNING OUT Pre-Registration Form
The 2-hour drop-off program runs weekly on Mondays 9:30 am - 11:30 am
Fee: $99.00/child for 4 weeks.


Parent or Guardian Information: Please fill out the information below:
Your First Name:
Your Last Name:
Your Street Address:
City, State, Zip Code:	,
Your Email Address:
Home Phone Number:
Cell Phone Number:

First Child Information:
First Name:
Date of Birth:
Any Allergies?
Register Second Child? Yes No

Notes / Comments:

Returning Customers:

If you know that we have your recent Credit Card information on file and you would like us to use it for payment, please enter the last 4 digits of your credit card number and the 3-digit CVN number, found on the back of the card:

Last 4 digits:

CVN Number

NOTE: Submitting this PRE-REGISTRATION FORM does not automatically register your child.
We will contact you to finalize your registration on a "first come - first served" basis.
* Due to limited space, no refunds or credits can be issued once the child is enrolled.
This program will end promptly at 11:00 am. All children are expected to be picked up by that time, without exceptions.
A $10.00 per child Late Pick-up Fee will be assessed for each 15 minutes after 11:00 am.