Register For a Class

Gymnastics Community Trust

North Harbour Gymnastics Centre

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This registration form is for new member use only.

Submission of this form and payment secures your child's place in his/her class. Thank you.

* indicates required fields

New Member? *	Yes No
Family Name *
Street Address *
Suburb *
Home Phone *
Cell Phone
E-Mail Address *
Parent/ Caregiver First Name *
Last Name (if different to Family Name)
Occupation
Work Phone
How did You Find Out About Our Classes? *
Details of the children you are registering. All fields are required except medical information.

First Child's Name *

Date of Birth *

dd/mm/yy (8 characters including /s)

Gender *

Name of School or Pre-School *

Select Term *

Please note: Below is a listing of all our classes. When you select a class we cannot guarantee availability until your selection is verified. Classes in red are now full if you select any of these classes you will be automatically placed on the class waitlist for the following term.

Sometimes spaces become available after the start of the term. A reduced term fee applies if we cannot place you until after the start of the new term.

This form will be received and class availability checked. If a space is allocated payment must be made immediately as demand for the classes is high. This can be done by internet banking or credit card over phone on (09)443 2570.

Select Class

Important Medical or Other Information

Second Child's Name
Date of Birth	dd/mm/yy
Gender
Name of School or Pre-School
Select Term
Select Class
Select Class
Select Class

Important Medical or Other Information

If there is no space in those classes what is your next preferred day and time?

Alternative Day
Alternative Time

Please Select how you wish to pay*

Visa

Mastercard

Internet Banking via your bank's website


Credit Card Number :
Expiry Date :	mm/yy
Name on Card :

Internet Banking

Important: Account reference numbers will be provided for you to enter in payee details sections.
	Our account number is	12 3050 0283567 000

Other Comments

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