Panthers Gymnastics Club

Please type in the required information. Then print.

Credit Card Information    Please select Visa or Master Card: 

Card Holder (as on credit card):

  


I authorize Panthers Gymnastics to charge, my credit card, fees described in the
registration package in full or monthly installments as per the online enrollment contract.

Payment(s)    Please select in full or in Installments: 

Per the online enrollment contract for:
Child's Name:

Class:             

Class Day:        Time:   

I also authorize Panthers Gymnastics to charge, my credit card, fees for unfulfilled
assessment requirements as outlined in the contract.

Card Holder's Signature:_________________________________________

                               Date:_________________________________________


Please print, sign and return ASAP to the office.*

                                    * N.B.:Registration will not be fully processed until Panthers Office receives this form.