SCHEDULE A CLASS

Please fill out the following form to request a class. We will call you to confirm your spot. For immediate assistance, please call 617.789.3669.

* Required fields

PARENT'S INFORMATION
First name:*

Last name:*

Address:*

City:*

State:*

Zip code:*

Phone number:*

E-mail address:*

My Gym Location:*

Type of Request:

FIRST CHILD
Child's first name:*

Child's last name:*

Birthdate:*

1st choice date & time:*

2nd choice date & time:

SECOND CHILD
Child's first name:

Child's last name:

Birthdate:	(not needed for makeup)

1st choice date & time:

2nd choice date & time:

ADDITIONAL INFO
How did you hear about My Gym?*

If referred by a friend, please provide their name¹:

Comments or questions:

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¹Please provide your friend's name in order to receive a credit through our Buddy Referral Program.