Fit Kids Factory Central Elementary After School Fitness Program

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Phone:
• * Cell Phone:
• * What is your child's name?
• * Grade
• * Homeroom Teacher

• Fee

  Type	Fee
  1 child	$52.00
  2 children	$54.00
  3 children	$150.00
  4 children	$208.00

Custom Information 1

• * Please describe your child's strengths, interests, and personality. Is there anything that would be helpful for our Coaches to know about your child to help them have an awesome experience at the Fit Kids Factory?
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• * Are there any medical concerns, special needs including any mental health diagnosis, restrictions, allergies, or anything else that our Coaches need to be aware of?
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• *

  Does your child have current medical insurance?

  • Yes
  • No
• * Please list authorized adults who will be permitted to transport your child home and relationship.
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Additional Child's Information

You may add a maximum of 4