APPLY FOR A REBALANCE CLASS

Application Form (Step 1)

First, fill out the Application Form below.

Student's Name / Nombre del Estudiante *

First

Last

Parent/Guardian Name / Nombre del Papa *

First

Last

Parent/Guardian Email / El Correo Electrónico del Papa *

Parent/Guardian Phone / El Teléfono del Papa *

Are You a Parent or Case Manager? / Eres un Papa o el Caso Director? *

• Parent/Guardian / Papa
• Case Manager / Caso Directo

Student's Age / Estudiante Anos *

Student's Grade in School / Estudiante el Grado *

What Class Are You Interested In? / Qual Clases Que Queras Hacer? *

• Obstacle Course / El Recorrido de Obstáculos
• Music / La Música
• Skate / El Monopatín
• Art / El Arte

Any Notes or Questions? / Prejuntas?

Any Food Allergies? / Alergias Alimentarias?

Submit / Enviar

Follow-Up (Step 3)

Our Program Director will be in touch with you soon!