ImpAct Enrollment Form
Customer information for ImpAct Youth fitness classes.
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Email *
Parent's Name *
Phone number *
Address *
Child's Name *
2nd Child's Name
Child's Age and DOB *
2nd Child's Age and DOB
List any health issues to be aware of.
Youth Shirt Size
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I understand that ImpAct Youth Fitness is a voluntary program. Enrollment isn't complete until payment has been made. *
Periodically pictures are taken for promotional purposes only. Please let us know if you are alright with pictures or video of your child. Please check appropriate box. *
A copy of your responses will be emailed to the address you provided.
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