Membership Registration Form

Membership Registration Form

Please fill out the form to register for Pulse Kids membership.
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
School Currently Attending
Gender
Is your child physically able to participate in active movement sessions?
PULSE STARTER KIT (ADD ON)
$75 Bds

Includes:
T-shirt | Sweatband set | Water bottle
Interested in Pulse Starter Kit?
T-Shirt Size (if yes)
What are your goals for your child in Pulse?

Other
Parent's Name

First NameLast Name
Relationship Status
Relationship to Child
Email Address
example@example.com
Phone Number (WhatsApp preferred)
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Membership Type
Preferred Time Slot
Emergency Contact Name

First NameLast Name
Relationship to Child

Other
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.

EMERGENCY & MEDICAL CONSENT
Consent to administer Basic First Aid
Permission to seek emergency medical care if needed
MEDIA CONSENT
Permission to take photos/videos
PAYMENT AGREEMENT
All Pulse sessions must be paid for in advance to confirm your child’s spot.

Drop-in sessions are payable before each session.

Monthly memberships are payable in full and secure a reserved spot for your child each week.

Please note:
- Payments are non-refundable for missed sessions.
- Monthly memberships are not transferable to other dates or persons.
We understand that life happens, and communication is always appreciated.
Participation Waiver – Pulse Sessions
I, the undersigned parent/guardian, understand that Pulse is a high-energy movement program that includes activities such as running, jumping, coordination exercises, and general physical play.

I acknowledge that while all reasonable care and supervision will be provided by Little Leaf Kids, participation in physical activity carries a level of inherent risk, including but not limited to minor injuries such as slips, falls, or collisions.

I confirm that my child is physically able to participate in these activities and that I have disclosed any medical conditions, injuries, or limitations that may affect their participation.

I agree that my child participates in Pulse at my own risk and I release and hold harmless Little Leaf Kids, its owners, staff, and instructors from any claims, liabilities, or damages arising from participation in the program, except in cases of gross negligence.

In the event of an emergency, I authorize Little Leaf Kids to administer basic first aid and, if necessary, seek medical attention for my child. I understand that every effort will be made to contact me immediately.

I also acknowledge and agree to follow all program guidelines, arrival and pick-up procedures, and safety instructions provided by the team.
Should be Empty:

Membership Registration Form

EMERGENCY & MEDICAL CONSENT

MEDIA CONSENT

PAYMENT AGREEMENT

Participation Waiver – Pulse Sessions