ACTIVE Kids Sports Academy Registration Form
Please complete the form below to register your child for the ACTIVE Kids Sports Academy.
Child's Information
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Gender
Please Select
Male
Female
N/A
Program Selection:
*
If here are no spaces available. We encourage you to join our waitlist to be notified when a spot opens up
.
Join Our Waitlist
Parent/Guardian Information
Parent/Guardian Full Name
Relationship to Child
Email
example@example.com
Phone Number
Please enter a valid phone number.
Medical Information
Does your child have any allergies, medical conditions, or physical limitations?
Yes
No
Please specify medical condition
Is your child currently taking any medications?
Yes
No
Please specify medications
Physicians Name
Physicians Contact Number
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact Name
Relationship to Child:
Emergency Contact Phone Number:
Please enter a valid phone number.
Permissions & Agreements
Photo/Video Consent
Do you give permission for your child’s photos/videos to be used for promotional purposes by ACTIVE Kids Sports Academy?
Yes
No
Medical Treatment Consent:
In the case of an emergency, do you authorize the staff to seek medical treatment for your child?
Yes
No
Terms & Conditions:
I confirm that I have read and understood the terms and conditions of ACTIVE Kids Sports Academy.
Agree
I hereby declare that the information provided is accurate and that I am the legal parent/guardian of the child.
Submit
Should be Empty: