Request for Private Lesson - Foothills Gymnastics 828-328-3794 by 78zq4k7

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									                 920 29th Avenue NE, Hickory, NC 28601
                 Phone: (828) 328-3794
                 Web: www.foothillsgym.com
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                  Gymnastics       Tumbling     Cheer  Dance Martial Arts


                          Request for a Private Lesson
Student’s Name: __________________________________                sex: M / F     Date of Birth: ___/___/___
Responsible Party that will be bringing the student to the private lesson: ______________________________
Contact Phone #: _______________________            Alternate Phone #: ______________________
Emergency Contact: ____________________             Emergency Contact Phone #: _____________________

Instructors Available:                                Becky Bryant
        Please write # 1 in the box next to your      Shawn Bryant
        first choice of instructor and # 2 in the     Adonus Chambers
        box next to your second choice.               Amber Herman
                                                      Kati Hicks
                                                      Tyler Matthews
                                                      Steven Rhoney
                                                      Joe Weaver
                                                      Jessica Wise
                                                      Cory Wooten


Type of Lesson:                                       Gymnastics
       Please check the box next to the type of       Tumbling
       private lesson that you would like.            Cheer Stunting (Tyler or Stephen only)
Gym Member Lesson Length & Cost:                      Half Hour Private (Single Student)         $25
       If you are a gym member, please check          Half Hour Semi-Private (Two Students)      $15 each
       the box next to the length of the private      Half Hour Tri-Private (Three Students)     $10 each
       lesson that you would like.                    Full Hour Private (Single Student)         $40
                                                      Full Hour Semi-Private (Two Students)      $22.50 each
                                                      Full Hour Tri-Private (Three Students)     $15 each
Non Gym Member Lesson Length & Cost:                  Half Hour Private (Single Student)         $35
      If you are not a gym member, please             Half Hour Semi-Private (Two Students)      $20 each
      check the box next to the length of the         Half Hour Tri-Private (Three Students      $15 each
      private lesson that you would like.             Full Hour Private (Single Student)         $50
                                                      Full Hour Semi-Private (Two Students)      $27.50 each
                                                      Full Hour Tri-Private (Three Students)     $20 each

Day & Time that works out best for you: ____________________________
                    **For Multiple Student Lessons please hand in request together**
                ***An instructor will be in contact with you about your Private Lesson***
        ****A Responsible Party is required to be present during the duration of the private lesson****

								
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