Level Up Kids Club Registration

Parent/Guardian Information

Parent/Guardian Full Name

Email Address Phone Number

Preferred Contact Method Email Phone Call Text Message

Number of Children Registering

How many children are you registering for Level Up Kids Club? 1 child$250 total 2 children$450 total 3 children$650 total

Child 1 Information

Child 1 First Name Child 1 Last Name

Child 1 Date of Birth Child 1 Age

What would you like Child 1 to gain from this group?

Anything helpful for us to know about Child 1 before the group starts?

Child 2 Information

Child 2 First Name Child 2 Last Name

Child 2 Date of Birth Child 2 Age

What would you like Child 2 to gain from this group?

Anything helpful for us to know about Child 2 before the group starts?

Child 3 Information

Child 3 First Name Child 3 Last Name

Child 3 Date of Birth Child 3 Age

What would you like Child 3 to gain from this group?

Anything helpful for us to know about Child 3 before the group starts?

Emergency Contact

Emergency Contact Full Name Emergency Contact Phone Number

Acknowledgments

Parent/Guardian ConfirmationI confirm that I am the parent or legal guardian of the child or children being registered, or that I have permission to complete this registration. Accurate InformationI understand that I am responsible for providing accurate contact, child, and emergency contact information. Drop-Off & Pick-Up ResponsibilityI understand that I am responsible for making sure my child is dropped off and picked up on time for each session. Fun WarningI understand that my child may have so much fun that they forget they are practicing important life skills.