Register your child for a Program - GOL Enrichment Programs, Virginia

MEDICAL RELEASE: In the event the parent(s) or persons named cannot be reached during an emergency involving the above named participant, I give my permission to GOL, LLC staff to secure all necessary and required medical treatment.

Participants Name*

Age of Child*

Parent/Guardian Name*

Email Address*

Daytime Phone*

Evening Phone*

Emergency Contact*

Emergency Contact Phone*

Choose an Available Session*

By selecting Submit, I hereby waive and release any and all rights and claims for damages I or my child may have against GOL, LLC, their representatives, successors and assigns, for any and all injuries, physical and mental, suffered by my child on any activity sponsored by these groups. I do hereby grant and give the right to use my child's photograph or image both single and in conjunction with other persons or objects for the purpose of advertising and publicity only. I hereby also agree to hold GOL, LLC and its representatives, harmless of and from any and all liability of whatever nature which may arise out of or result from uses stated above. For the consideration stated above, I further agree that I will personally indemnify and save harmless GOL, LLC and their successors, representatives and assigns, for any and all loss or damage occasioned hereby.

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Toddler playing during child enrichment program

Please complete our registration form below. Once we receive your form we will contact you to confirm enrollment. If you'd rather register in person, click here to download the PDF version of our Registration Form.

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School Name*

DO NOT PAY ON PAYPAL UNLESS YOU HAVE A SCHOOL CODE. IF YOU DON'T HAVE A SCHOOL CODE PLEASE ASK YOUR SCHOOL TO REQUEST ONE FROM US. SCHOOL CODES APPEAR ON NEXT PAGE. IF YOU ARE NOT A SCHOOL, PLEASE PROCEED. THANK YOU.

Prices that follow DO NOT include discount for cash.

Program (i.e. Dance, Soccer, Yoga)*