Registration Form - Communities in Motion

Student's Name * First Last
Student's Birthday * / MM / DD YYYY
Age *
Gender *

Gender Female Male
Parent or Legal Guardian Information
Mother's Name * First Last
Father's Name * First Last
Email *
Home Phone Number * - ### - ### ####
Mobile Phone Number - ### - ### ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Registration Information
Choose Session *

Choose Session Fall Session 1 Fall Session 2 Fall Session 3 Winter Session 1 Winter Session 2 Spring Session 1 Spring Session 2 Summer Session Summer Camp
Name of class signing up for *
Date and Time of the class *
Payment Method

(If you need to make payment the first day of class your spot is not guaranteed in the class.
Due to safety issues and room occupancy limitations we only take a limited amount of registrations. Please contact your community center and register at least one week prior to guarantee your spot in the class.) *

Payment Method

(If you need to make payment the first day of class your spot is not guaranteed in the class.
Due to safety issues and room occupancy limitations we only take a limited amount of registrations. Please contact your community center and register at least one week prior to guarantee your spot in the class.) Payment Via Local Recreation Center (Pay the Community Center in Person or Via the City Website for the city of Beachwood. Some cities may not take registration over the phone and will require you to fill out their forms as well) Online Payment via PayPal (Blue Box above in Right hand column)
Photo & Publication Permission - I give Communities in Motion/Ovation Movement permission to take pictures for use on the website and other marketing strategies. *

Photo & Publication Permission - I give Communities in Motion/Ovation Movement permission to take pictures for use on the website and other marketing strategies. Yes No
Disclaimer: I hereby release and hold harmless Communities in Motion/Ovation Movement (Traci McCormick and her Instructors) from any and all claims, costs, damages, and liablitites for any injuries sustained by my participation in any program offered by or in any facilities of the above name. I understand that I am physically capable of participating in the program in which I am enrolled, based upon consultation with my personal physician. *
I have read and agree to the terms in the disclaimer above.
Are there any physical limitations or concerns that would be helpful to the instructor? *
How did you hear about us?
Type the letters you see in the image below.

Registration Form - Communities in Motion

Registration Form - Communities in Motion

Parent or Legal Guardian Information

Registration Information