Homeschool P.E. Registration & Payment Form

Homeschool P.E. Registration & Payment Form

Classes are every Thursday at 12:00 pm.
Applicant Information
Students Name

First NameMiddle NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any Allergies or Other Concerns:
Any medical conditions or concerns:

Parental Information
Name of Mother

First NameMiddle NameLast Name
Mother's Job/Position
Mobile Number
Address of Mother

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father

First NameMiddle NameLast Name
Father's Job/Position
Mobile Number
Address of Father (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Full Name of Applicant

First NameLast Name
Waiver and Policies
I hereby affirm that I have read and understood all the instructions regarding my application and read the waiver above for the Key Life Fitness Homeschool Program in Florida. I confirm that all information provided in this application is complete and accurate. I understand that any or all information given may be verified against official documents. I acknowledge that withholding or providing false information will result in ineligibility for admission or may lead to dismissal. If admitted, I agree to abide by the policies, rules, and regulations of Key Life Fitness.
Applicant's Signature

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Applicant Information