GOC Registration Form - JAMSpiritSites.com

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How did you hear about us? Referral Name? Monthly tuition for Gem of Champions is due by the 10th of each month. A late fee of $25 will be added.

GEM OF CHAMPIONS REGISTRATION FORM Athlete’s Name ____________________________________ Athlete’s DOB _________ M or F Age _______ School Attending _____________________________

Grade _________

Parent / Guardian’s Name _______________________________ Relation to Athlete __________ Home Address _______________________________________________________________ If Billing Address is different, please list: _______________________________________ Home # ________________________________ Cell # _____________________________ Email __________________________________ Alternate Email _____________________ Any additional notes (Best time to reach, can you receive texts, etc?) ___________________________________________________________________________________ Emergency Contact’s Name _____________________________________ Relation ___________ Home # ______________________________ Cell # ________________________________ Insurance Provider ______________________________ Policy # __________________________ Allergies / Health Conditions: _______________________________________________________ How did you hear about us? __________________________ Referral Name?________________ Monthly tuition for Gem of Champions is due by the 10th of each month. A late fee of $25 will be added to my account if payment is not received by the 10th of the month. In order to become inactive, I must provide written notice to GOC by the 25th of the month. Parent / Guardian __________________________________________ Date __________________ ******************************FOR OFFICE USE ONLY*************************** $35 Registration Fee Pd? _________ Date Pd? _________ Jackrabbit Setup Completed By? ____________________ Date Completed? _______________

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