Alpha Fitness Club Summer Program Registration

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* 1. Child's name:

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* 2. Age of Child:

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* 3. Child's Date of Birth:

Date / Time

Date

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* 4. Which program are you enrolling in?

AGILITY / CONDITIONING

LIFTING 101

BOTH

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* 5. Child's primary sport (if applicable):

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* 6. Parent / Guardian Contact Name:

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* 7. Phone Number AND Email:

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* 8. Address:

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* 9. By clicking 'YES' I agree that my child is not fully registered until payment is made to Alpha Fitness Club (Cash or Check ONLY)

Yes

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* 10. By clicking 'YES' I understand that I MUST sign a Waiver and Release form in order for my child to participate in either Summer Program at Alpha Fitness Club

Yes