Your Information

Parent's First Name *

Parent's Last Name *

Phone *

Email *

Address

Street Address

City

State

Postal Code

Child's Information

Athlete Name *

Child's Date of Birth *

Payment Information

Upon completion of this form, you will become a member of Quantum and receive all member benefits. An annual registration fee of $25 per child will be charged today. You will still owe the membership price you selected above each month. Regular fees for the classes will be automatically charged each month on the 6th. A card will need to be provided on your child's first day to have on file for regular monthly billing. We do require you to notify our office prior to the 1st of the month if you would like to drop at any time.

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