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Parent First Name

Parent Last Name

Phone

Child First Name

Child Last Name

+ Add additional child

+ Remove child 2

Child First Name 2

Child Last Name 2

+ Add additional child

+ Remove child 3

Child First Name 3

Child Last Name 3

I affirm that neither my child nor I, nor any other immediate family member, has experienced any signs of illness, including but not limited to fever, runny nose, cough, sore throat, shortness of breath, chills, rash, etc. in the last 48 hours.

I affirm that neither my child nor I, nor any other immediate family member has experienced any signs of a gastrointestinal illness, including but not limited to vomiting, diarrhea, etc. in the last 72 hours.

My Gym Gripper socks are required for children, adults wear socks.

Chaperone Name (if different)

Chaperone Phone

Today's Date

My Gym Class Check In