Greenlit Training Program

1. Child's Name(First/Middle/Last)

Date of Birth

Sex

Male
Female

Height (Ex: 5' 2")

Weight (lbs)

2. Child's Name(First/Middle/Last)

Date of Birth

Sex

Male
Female

Height (Ex: 5' 2")

Weight (lbs)

Additional Children(Please list Name, Date of Birth, Sex, Height, and Weight)

Parent/Guardian #1

Home Address

City

Zip Code

Home Phone

Parent/Guardian#2

Home Address

City

Zip Code

Emergency Contact Information(First Name/Last Name/Phone)

My Child Has The Following Special Need(S). List Name and Need(s), if describing multiple children.

Upload picture: 1. Go to https://postimages.org/. 2. Select "800x600 (15-inch monitor)" on the drop box. 3. Select "Remove after 7 days" on the next drop down box. 4. Select your photo to send. 5. Copy the first "Link" listed and paste into the box below.

I verify the information given above to be correct and I understand that the completion of this form does not guarantee placement into the Greenlit Training Program . If my child is placed in the program, I agree that my child will attend the program for the required number of hours and days outlined by Greenlit Training Program handbook. I understand that failure to comply with these attendance requirements could result in dis-enrollment. I understand that I cannot register my child without a completed registration form, a signed handbook, a non-refundable registration fee, and a first week tuition fee payment. I, The Parent/Guardian, also agree to all Greenlit Training Program written policies. A copy of these policies are clearly stated in the Greenlit Training Program Handbook. All families will receive a copy of this Handbook upon enrollment.