ImpAct Enrollment Form
Customer information for ImpAct Youth fitness classes.
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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
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.
Yes it is alright.
No pictures are to be taken.
A copy of your responses will be emailed to the address you provided.
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