After School Enrollment

Child's Name*

First Last

Address*

Street Address City State ZIP Code

Gender*

Male
Female

Birthday*

Grade*

Phone*

Parents Name*

First Last

Email*

EMERGENCY INFORMATION:

Name*

EMERGENCY CONTACT 1

Phone*

Name

EMERGENCY CONTACT 2 - optional

Phone

CHILD RELEASE AUTHORIZATION:

Name & Relationship*

Phone*

Name & Relationship*

Phone*

Name & Relationship*

Phone*

DOES YOUR CHILD HAVE ANY ALLERGIES?

Hay Fever*

Yes
No

Poison Oak/Ivy*

Yes
No

Bee Sting*

Yes
No

Penicillin*

Yes
No

Food Allergies*

Yes
No

If "YES" please list food allergies

I authorize KidSportz USA staff to apply sunscreen to my child's exposed skin.*

Yes

Initial below if you agree with terms of agreement*

I am over the age of 18 and wish to enroll my child in Kidsportz USA. I agree that Kidsportz USA is not responsible for any accidents that happen to my child while in the Kidsportz USA program. I understand that the Kidsportz USA training programs are not medically supervised programs and that these programs were developed for healthy people with no medical conditions or risks (physical or psychological). If my child has an existing medical condition, I will present my coach with a physicians release form, signed and dated by their personal physician. This form represents my physicians approval to participate in the Kidsportz USA training program. I understand that this form must be submitted before you can officially enroll your child. I grant permission to my coach to contact my physician or healthcare professional if I require medical supervision during my childs participation in the training program. No refunds. *Parents must pick up child(ren) no later than 5 minutes after class.

PLEASE SELECT WHICH AFTER-SCHOOL PROGRAM YOU WOULD LIKE TO ENROLL IN:

Choose one option below:*

1 Day After-School Sports & Fitness = $75 monthly
2 Day After-School Sports & Fitness = $150 monthly
3 Day After-School Sports & Fitness = $200 monthly
4 Day After-School Sports & Fitness = $250 monthly

Which days do you need to enroll for?*

Please choose the days based on the monthly option you chose above.

Mondays
Tuesdays
Wednesdays
Thursdays
Fridays

CLICK BELOW TO COMPLETE REGISTRATION.
You will be taken to Paypal to complete the purchase.

* PLEASE NOTE: There is a setup fee of $49 that will be added to the total.

Phone

This field is for validation purposes and should be left unchanged.

After School Enrollment

After School Registration Form 2020

EMERGENCY INFORMATION:

CHILD RELEASE AUTHORIZATION:

DOES YOUR CHILD HAVE ANY ALLERGIES?

PLEASE SELECT WHICH AFTER-SCHOOL PROGRAM YOU WOULD LIKE TO ENROLL IN: