Throw on some work out shorts
and be here by six
Mom and Dad need a break
We’re having Kids Olympics!
We’ll eat pizza
and create some fun art
Make your way to the gym
and get ready to start
Red or Blue
which team will win?
Can’t wait to see you
Let the games begin!
Kids Fit Fun FACtory
Saturday, September 10th
6:00 – 9:00 PM Kids ages 4 – 12 years old
Members: $20 per child
Non-Members: $25 per child
Registration due by: Sept 9th, 12 noon
Stop by the Kids FACtory to register or call 479-587-0500 ext. 7
Fayetteville Athletic Club 2920 East Zion Road, Fayetteville, AR 72703
Kids Night Out - Olympic Night
Saturday, September 10, 2016
Time: 6:00 to 9:00 pm
All registration forms are due by Friday, 12:00 Noon
CHILD'S NAME:
Date of birth:
CHILD'S NAME:
Date of birth:
CHILD'S NAME:
Date of birth:
Child's Street Address
City:
State:
Zip:
Primary Caregiver Name:
email:
Relationship
Work phone:
Cell phone:
Secondary Caregiver Name:
email:
Relationship
Work phone:
Cell phone:
Name:
Relationship
email:
Cell phone:
Emergency contact
Epi-Pen/ Epinephrine
Antihistamine
Rescue Inhaler
Diabetic Insulin
Other: ___________________________
Medical Emergency Information
Member rate:
$20 per child
Non-member rate:
$25 per child
METHOD OF PAYMENT:
Credit Card
#
Name as it appears on your card:
Please charge my card on file.
Expiration date:
Cash: $
Check #
Your child must be checked in by 9:00 AM daily. We reserve the right to deny any late drop offs
I agree to assume full risk and release all claims I and/or the participants may have against the Fayetteville Athletic Club (FAC), The Kids Club Fit Fun
FACtory including it's agents, servants and employees, from such claims resulting from injury, damages or loss sustained during participation in any
FAC off site parent program or event. I understand that I am responsible for all personal medical insurance and the participant's family must cover any
cost incurred. I also understand that every precaution is taken to protect the safety of all participants. I agree to any emergency treatment by a
physician or hospital in the event that the emergency contact listed above can not be reached.
Signature of Parent or Guardian:
Date:
FAC team member name:
Date:
Please return all completed registration forms to the FACtory Front Desk.