Exit this survey

January 10 Take Action in the Pool Registration

Registration

Thank you for registering for a ProActive Kids Take Action Day!

We will recap all the great lessons you learned at PAK, see your PAK friends, and have some fun as a family! And… it gives us a chance to see you all again and see how you have progressed since attending PAK.

(One parent or guardian MUST attend with the child - adults will not swim. Children cannot attend alone).

Who: Anyone who attended or plans to attend ProActive Kids programs
Date: Saturday, Jan 10
Time: 12:30 - 1:30
Location: Edward Health and Fitness Center at Seven Bridges Pool (Woodridge location)

If you have any questions, please contact ProActive Kids at info@proactivekids.org.

Question Title

* 1. Please enter your name and contact information.

Child Name:

Parent Name:

City/Town:

Email Address:

Phone Number:

Question Title

* 2. Tell us more about how your have implemented PAK lessons in your home.

Question Title

* 3. Using a scale of 1-10, is your child continuing the success they saw at PAK and living a healthier lifestyle and continuing to decrease or maintain their weight ? (1 being lowest, 10 being highest)

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10