Healthy Champions Afterschool Program Registration "*" indicates required fields Step 1 of 4 - Student Information 25% CommentsThis field is for validation purposes and should be left unchanged.Student InformationStudent Name* First Last AddressStreet, City, StateGender Male Female Date Of BirthMM/DD/YYYYAgeHeightWeightGrade LevelSchool Name Parent or Legal Guardian InformationParent or Legal Guardian #1 InformationName* First Last Phone (Cell)*Phone (Home)Email* Parent or Legal Guardian #2 InformationName First Last Phone (Cell)Phone (Home)Email Student Scholarship QuestionnaireWhy do you want to participate in X3 Foundation Program?Do you have any sports/martial arts experience? If yes, please list.Are you involved in any other extracurricular or school activities? If yes, please list.Who is your role model and why?What are your future goals/dreams?How will you achieve your future goals/dreams?How do you define success for yourself?Do you have transportation to attend the X3 Foundation program?Participant's Name Parent/Guardian AgreementPlease read the following information carefully. You must sign at the bottom indicating that you understand and agree to all of the following. Program Information, Requirements, and Rules1. Enrollment: Enrollment is limited. Our hope is to have enough room for all children wishing to participate in our X3 Foundation Program; however, we cannot always accommodate everyone. After receiving your completed forms, the X3 Foundation Staff will call to let you know if your child will be participating in the program and the date that they may begin.*2. Attendance: Students must attend the program weekly on Tuesday and Thursday. Regular attendance is mandatory. Children are expected to stay for the entire duration of the After School Program each day. If a student is absent, written or verbal notification must be submitted or communicated to the X3 Foundation Program Staff by the next program day. Students must attend 75% of classes monthly to remain eligible for the program.*3. Equipment: All equipment required for participation will remain at X3 Sports for the first 6-month period. Any equipment damaged or destroyed by negligence or misuse must be replaced at your cost. Please wear appropriate clothing to every class.*4. Transportation: To participate in the X3 Foundation Program, you must have reliable transportation to and from school to X3 Sports. My child has permission to walk home from the X3 Foundation Program or my child will be picked up by you or designated person at least 16 years of age. Your child must be picked up promptly at the end of the program. Please select from the options listed.*How will the participant get to/from our facility?* Walk Designated Person Pick-Up 5. Discipline: Participation in the X3 Foundation Program is a privilege. A child must follow the rules of the program. Disruptive or disrespectful behavior towards other students or staff is cause for dismissal. We encourage you to discuss concerns about your child’s behavior with the X3 Foundation Staff*6. Parental Support: While X3 Foundation Program Staff are committed and qualified, your help is needed to make the program the very best it can be. You are an important partner in our program’s success, and we look forward to your help with events and activities and other projects.*7. I have read and understand all the information above on this X3 Foundation Program Parent Agreement and I give permission for my child to attend the after-school program. All the information in my child’s after school registration form and the after-school emergency card is complete. I agree to follow the rules of the program and to help my child understand and follow the rules.*Please Print Name of Parent/Guardian:*Date*MM/DD/YYYY