Move IT! Kidz 4 Fitness LLC Online Registration

Registration

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Welcome to Kidz 4 Fitness! We’re thrilled to have you on board. To complete your enrollment and secure a spot in our classes, please fill out the registration form below. If you have any questions or need assistance with the registration process, don’t hesitate to reach out. We’re here to help! Looking forward to having you with us.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name & Number (Not Contact #1 or #2)*

Contact #1

Parent #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work # *

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Parent #2 First Name

Last Name

Type*

How can we contact you?

Home Phone *

Work # *

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites (Wheel chair, etc. )*

Special Needs (Autism, ADHD, etc.)*

List ALL Allergies (food and other)*

Medications (Asthma inhaler, EpiPen, etc.)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites (Wheel chair, etc. )*

Special Needs (Autism, ADHD, etc.)*

List ALL Allergies (food and other)*

Medications (Asthma inhaler, EpiPen, etc.)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites (Wheel chair, etc. )*

Special Needs (Autism, ADHD, etc.)*

List ALL Allergies (food and other)*

Medications (Asthma inhaler, EpiPen, etc.)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites (Wheel chair, etc. )*

Special Needs (Autism, ADHD, etc.)*

List ALL Allergies (food and other)*

Medications (Asthma inhaler, EpiPen, etc.)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size*

School*

Grade Level*

Disabilites (Wheel chair, etc. )*

Special Needs (Autism, ADHD, etc.)*

List ALL Allergies (food and other)*

Medications (Asthma inhaler, EpiPen, etc.)*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)