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Galveston Gymnastics

CREDIT CARD AUTHORIZATION 
A credit card authorization is required for all card payments. Thank you for your understanding. 


First Cardholder Name
First Name*
Last Name*
Phone*
First Cardholder Date of Birth*
Date of Birth
First Cardholder Signature*
Second Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Third Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Fourth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Fifth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Sixth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Seventh Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Eighth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Ninth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Tenth Cardholder Name
First Name*
Last Name*
Cardholder Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Credit card authorization
Name
Card type
Card number
Expiration
Security code
Billing zip code
Authorization
I authorize Galveston Gymnastics LLC to charge my credit card above for agreed upon reoccurring charges and purchases. I understand that my information will be saved to file for future transactions on my account. *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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