Flipz for All — Assessment Form - East Coast Gymnastics & Cheer

Please fill out the Assessment Form below. One of our Team members will call or email with any follow up questions with in 3 business days.

Parent's First and Last Name: *

Phone Number: *

Numbers only

Email: *

Child's First and Last Name: *

Child's Date of Birth: *

Please enter in mm/dd/yyyy format.

Medical Diagnosis: *

Please describe your child's challenges?

Is your child potty trained? *

Is your child verbal? *

Can your child communicate their wants/needs? *

If other from above, please explain.

Why are you interested in your child joining an ECGC program? *

If other from above, please explain.

I understand that East Coast Gymnastics & Cheer provides adaptive gymnastics classes and activities for children with physical and neurological disabilities. At this time, E.C.G.C. does not offer other therapy. *

I have read the above statement and I understand that East Coast Gymnastics & Cheer, and/or staff, DOES NOT provide any specific therapy.