YOUTH PROGRAM REGISTRATION
Registration is not complete until this form has been filled out, and you have been sent the registration link. Once payment is confirmed, your registration is complete.
First and Last name (parent)
*
First and last name (child)
*
First Name
Last Name
Childs Birthdate
*
-
Month
-
Day
Year
Date
Full address
*
Phone Number
*
E-mail (parents contact)
*
example@example.com
Gender
*
female
male
non-binary
prefer not to say
Please select which program you are registering for.
*
LITTLE LIFTERS Mondays 5:00pm
LITTLE LIFTERS Wednesdays 5:00pm
INTERMEDIATE Thursdays 5:00pm
Does your child have any allergies? If yes, please describe, and describe protocols.
*
Does your child have any limitations or disabilities that would restrict them from participating in ALL of our activities ( climbing, jumping, walking, running, rolling, scavenger hunts, team work etc). Please describe the limitation/disability and give your general protocols for navigating.
*
Does your child take any medications? Please list/describe.
*
Does/will your child require additional assistance? If yes, are you able to provide additional assistance as required?
*
How did you hear about us? (Ie: Google search, Instagram, Facebook, or referral - please let us know who!etc)
*
Thank you for filling out our registration intake for our YOUTH PROGRAM!
Reminder: This is NOT confirmation of registration. Once this form has been received and reviewed, a member of our team will be in contact either with a link for registration and payment, or with further questions to confirm registration.
SUBMIT
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