Preschool Fitness - Stretch n Grow of Utah

Parent Paid Registration Form (optional)

Wasatch Family Fitness and Stretch-n-Grow of Utah conforms with Title 26 Chapter 53 Protection of Athletes Head Injuries Act as Amended.

Thank you for signing up for this Stretch-n-Grow of Utah program. Please fill out the following questions and checkmarks at the end indicating your online submission counts as your signature. Make sure you fill out all required fields.

Parent 1 Name (required)

2nd contact person can be added below.

Parent 1 Email (required)

Please use an email you check regularly.

Parent 1 Phone (required)

Used for emergency contact if needed.

Additional Contact Person (optional)

Parent 2 Name, Parent 2 Email, Parent 2 Phone

Child 1 Full Name (required)

First and Last Name

Child 1 Age (required)

Include Age and Birth Month and Year

Child 1 Health Concerns (required)

Do we need to know about any allergies or other health concerns?

Yes

No health concerns

Health Concerns Details (optional)

If you answered Yes, please give us any details we need to know for class planning and safety planning.

Class Location (required)

Select if you are registering for a Park City or Salt Lake City Class

Grace Lutheran Preschool

Mount Olympus (13 open)

Classroom Name - if known (optional)

Select Class (required)

Pick your age group and/or class duration.

Mount Olympus

Other, Comments or Questions (optional)

How did you hear about us? (Check those that apply) (optional)

Please list Name of School or Ad location in details field, or if you picked the Other option

Returning Customer

Friend

Posted Hard Copy Flyer

Website

Email Flyer

Facebook

School

Other

Details about referral source (optional)

Please help us shape our outreach efforts. Tell us more about how you found our classes.

Parent Release and Signature

Photo/Video Release: (optional)

By checking below I am submitting this online form in place of my initials as signed, acting as a parent or legal guardian for the child named above, I give my permission for his/her photographs and/or videos to be used in promotional and/or training purposes by Wasatch Family Fitness, Inc. or Stretch-N-Grow of Utah, Inc. I waive claim to any compensation for the use of these photographs and/or videos and also release Wasatch Family Fitness and Stretch-n-Grow of Utah from any future claims or liability related to this release.

Submitted as release: (required)

Yes I release

No I do not release

Financial Agreement: (optional)

By adding my name and date below, I am submitting this online form in place of my physical signature. I understand that I am enrolling my child in a Stretch-n-Grow of Utah or Wasatch Family Fitness Prepaid Program. I agree to pay for my child’s participation regardless of absences. A $10 late fee will be applied to my account if payments are not received by the close of the first class. An additional $10 fee will be applied monthly until the account is paid in full. In the event that payment under this agreement is not made at the time and in the manner required, the undersigned agrees to pay all costs of collection, including attorney fees, court costs, including charges and collection agency fee which would be 35% of the balance assigned, with or without suit.

Parent/Legal Guardian Signature and date signed: (required)

Type your full name and the date of this form submission

Class Payment is Next

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Preschool Fitness (3 yr. - 6 yr.)

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Parent Release and Signature

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