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2025-2026 AtlantiCare Kids360/Fit Families Event Request Form

Please fill out the form below if you would like to have a trainer from our AtlantiCare LifeCenter visit your school for a special fitness event and experience.
*Due to availability, there are a limited number of school visits to be scheduled.
*Each school may only submit one request for either Kids360 or Fit Families per school year.
*Waivers will need to be completed for each participant whether a student or family member.
Deadline for requests: May 1, 2026
1.Name of School:(Required.)
2.School Address: (Required.)
3.Name of Person Completing Request:(Required.)
4.Email of Person Completing Form:(Required.)
5.Alternate Contact Name:
(Back up person just in case you are absent the day of the event.)(Required.)
6.Alternate Contact Email:(Required.)
Please provide an estimate of the demographics of students participating in the activity:
7.Provide an estimated percentage:(Required.)
8.Provide an estimated percentage:(Required.)
9.Age Group:(Required.)
10.Please indicate if this is a Kids360 or Fit Families request.
(Each school may only submit 1 request for either Kids360 or Fit Families. A school cannot request both activities in a single school year.)(Required.)
11.Number of People:
(Due to the nature of this activity, class size is limited to 50 students. Please email healthyschools@atlanticare.org to discuss the possibility of adding more students.)(Required.)
12.Grade Level(s):
(Students must be ages 8+ in order to participate.)(Required.)
13.Room Type:
(ie: gym, cafeteria, etc. - larger, cleared spaces)
(Required.)
14.Please offer any additional information regarding student/family abilities so we may adapt this program as needed.
15.Requested Date:
(Please be as specific as possible to assist with scheduling and list multiple date options. Requests must be made at least 3 weeks in advance.)(Required.)
16.Requested Time:
(Please note start and end time, allowing 45 minutes for this activity.)(Required.)
17.Schools must provide a large, cleared space for physical activity stations. (Required.)
18.To celebrate AtlantiCare's ongoing partnership with area schools we would like to take photos/videos throughout the event. In preparation, all students and staff participating are requested to return a signed AtlantiCare photo/media release.
*All students will be allowed to participate in any AtlantiCare activity no matter their parent/guardian's approval or disapproval in completing this form. (Required.)
Thank you for submitting this request. An AtlantiCare Healthy Schools Team member will contact you within 72 hours to discuss the availability of our team and to schedule this activity.