Always in Motion Ninja & Parkour

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2026 Afterschool Registration

Parent/Guardian Information

Parent/Guardian Name*

Primary Phone*

Secondary Parent/Guardian Name

Secondary Phone

Email*

Child Information

Participant's Name*

Age*

Grade*

School Information

School Name*

Dismissal Time*

Time

:HoursMinutes

School Address (if known)

How is your child normally dismissed from school?

Bus Rider

Car Rider

Walker

Other

Does the school require any special pickup procedures or identification?*

Yes

Program Information

Will your child need transportation from school?*

Yes

Estimated Start Date and Estimated Pickup Time from AIM*

Month

Day

Year

Time

:HoursMinutes

Additional Notes or Questions

Authorized Pickup Contacts

Please list all adults authorized to pick up your child from the program.

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

Emergency Contact Info (Required)

Emergency Contact Name*

Emergency Contact Phone

Does your child have any allergies?*

Yes

Does your child have any medical conditions, medications or special considerations we should be aware of?*

Yes

Does your child have any behavioral, developmental or sensory needs our staff should be aware of?

Yes

Medical Release Agreement and Parental Consent

Students are expected to carry their own accident and/or medical insurance. Coaches and Instructors of AiM Ninja & Parkour are safety conscious and follow appropriate safety procedures. In the event of injury or illness, every effort will be made to contact the parent or guardian. If necessary, I authorize AiM Ninja & Parkour to administer First Aid and/or authorize medical treatment if necessary. The above-named student has had a medical examination within the last 12 months and can participate in Ninja and Parkour training.

Parent/Guardian Name*

Signature*

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Date

Month

Day

Year

How did you hear about us?

Current Member

Social Media

Friend / Word of Mouth

Flyer / Event