Contact form

Sterling Academy of Gymnastics & Dance
Sterling Martial Arts
Summer Programs Application Form

Required fields are marked with *

Parent / Legal Guardian

First name:*
Last name:*
Address:*
Apt #:
City:*
State/Province:*
Zip/Postal code:*
Home Phone:*
Work Phone:
E-mail:*
Emergency Contact Name:*
Emergency Contact Number:*
Person Responsible for Account / Billing:*
Relationship to Student:*
Billing Address:*
Billing Phone:*

Student 1

Name:*
Date of Birth:*
Age:*
Male / Female:*
Select the program you are registering for: Check all that apply	Gym Camp Dance Camp Martial Arts Camp Aerial Acro Camp Cheerleading Camp Swimming Lessons Martial Arts Class Dance Class Gymnastics Class
Class Day & Time or Camp Week (click below to see schedules) Classes Camp Weeks
Note: Class times and camp weeks are subject to availability.

Health History - Please check all that apply

Allergies Asthma Diabetes Convulsions Epilepsy

Heart Disease Frequent Ear Infections Frequent Headaches

Hearing or Sight Impairment Allergic to Insect Stings EpiPen

Food Allergies On Medication Regularly Physical Challenge

Does this student have any present physical or other limitations or restrictions?
If so, please explain:

I hereby enroll the above named student(s) in Sterling Academy of Gymnastics & Dance / Sterling Martial Arts. I recognize that any activity involving height or motion can create the possibility of injury. I also understand that gymnastics, dance, martial arts, rock climbing and cheering are inherently dangerous activities and that injury, or even death, may occur. I waive and release any and all injuries and damages suffered by enrollees in connection with the program. If for any reason, I myself enter the gym / studio areas, I waive and release any and all injuries and damages suffered as a result. My signature is my indication that I have read, understand, and agree to comply with all the rules, regulations, and policies of the Sterling Academy of Gymnastics & Dance and Sterling Martial Arts. I also understand the make-up policy regarding students enrolled in gymnastics, dance, martial arts and camp. I understand if the above named student(s) are absent for 2 consecutive weeks, and tuition payment has not been received and Sterling Academy is not notified, the reserved class day and time for the student(s) will be forfeited. In an effort to maintain the integrity of these programs, Sterling Academy reserves the right to terminate any student's enrollment at any time. My signature is my indication that I have read, understand, and agree to comply with all the rules, regulations, and policies of Sterling Academy of Gymnastics & Dance, Sterling Martial Arts, and all related programs.

This online application is not complete until your deposit has been made.
You will receive an email from Sterling Gym with additional information and deposit amount due.
Immunization records are REQUIRED to be on file prior to attendance at Sterling Camp.

Name of Parent / Legal Guardian:*
Date:*