SNACK Free Trial Request (Virtual Classes)
Thanks for your interest in SNACK! Please complete the required questions on this brief form. Someone from our organization will reach you by email to answer any questions and assist with scheduling a free trial class.
Email address *
First Name (Parent/Guardian) *
Last Name (Parent/Guardian) *
Cell Phone # of Parent/Guardian *
First Name (Child/Participant) *
Last Name (Child/Participant) *
Current age of child/participant *
Please select one class that you would like to try first. *
Please select the preferred time for the child/participant to participate in SNACK classes. *
Required
(optional) Our usual in-person schedule is currently suspended. When we resume, are you interested in attending classes in-person at our facilities on E 53rd St?
Clear selection
(optional) Are you seeking reimbursement through self direction? If so, please let us know the details including your agency/fiscal intermediary.
(optional) Our weekly virtual classes are currently $30 each. If you are currently unable to afford this rate, please enter an amount that you would be able to pay per class.
Submit
Never submit passwords through Google Forms.
This form was created inside of SNACK & Friends Inc.. Report Abuse