Jumpstart 2025-26 Registration – Fayetteville Athletic Club

2025-2026 Jumpstart Preschool Registration (ages 1-5 years)

Registration Fee $50.00 Monday -Friday 7:30-6:00 Members $199/$209 Guest. 3 Days Option 7:30-6:00 Member $159/169 Guest

Child's Name(Required)

First Last

Birth Date(Required)

Age as of August 1, 2025(Required)

1 years old

2 years old

3 years old

4 years old

5 years old

Primary Parent/ Caregiver Name(Required)

First Last

Relationship to child:(Required)

1st Parent/ Guardian Cell Phone(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Parent/ Caregiver's Place of Employment(Required)

Work Phone(Required)

1st Parent/ Caregiver Email(Required)

Secondary Caregiver Name

First Last

Secondary Caregiver Cell Phone

Secondary Caregiver Address

Street Address Address Line 2 City State ZIP Code

Secondary Parent/ Cargiver's Employer

Secondary Parent/ Caregiver Work Phone

EMERGENCY CONTACT /NAME OF PERSON TO CALL IF PARENTS CAN NOT BE REACHED(Required)

Emergency Contact Cell Phone(Required)

Emergency Contact Email(Required)

Emergency Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

Is the emergency contact authorized to take the child from FAC?(Required)

List all other adults who are authorized to take the child from the center:

Name

First Last

Relationship

Cell Phone

Name

First Last

Relationship

Cell Phone

Name

First Last

Relationship

Cell Phone

Signature(Required)

Child Medical Information

Allergies? (n/a if none)(Required)

Physical or Emotional Concerns Your Child May Have:

Special Food Needs?

Prescribed Diet:

Other Conditions or Comments?

Please Select All of The Following Conditions/Illnesses That Your Child Has Had:(Required)

Hospital Emergency Room of Choice:(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

I, (mother/father/guardian), do hereby give my consent to the Director of the Child Care facility, or his/her representative, for said child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of emergency when parent/guardian can not be reached. Consent is also given for the Director or his/her duly appointed representative to transport said child for emergency medical treatment, if the parents cannot be reached. Please sign below.(Required)

I give, or do not give the Director of the Kid's FACtory or his/her appointed representative, permission to give my child Acetaminophen. I understand that I will be notified if that medication has been administered(Required)

Signature(Required)

I give, or do not give the Director of the Kid's FACtory or his/her appointed representative, permission to use sunscreen/ suntan lotion on my child, when weather permits. I understand that school age children may apply sunscreen to themselves with supervision.This consent is in accordance with Minimum Licensing Requirements: DCCECE/ Child Care Licensing Unit: 1100.1101.17(Required)

Signature(Required)

ACKNOWLEDGMENTS

This is a statement of verification that I have been informed that child care licensing/ child maltreatment investigators and/or law enforcement may possibly interview my child for the purpose of determining licensing compliance or for investigative purposes. This is accordance with Minimum Licensing Requirements: DCCEDE/ Child Care Licensing Unit: 200.201.4

Signature(Required)

Discipline Policy(Required)

The discipline policy of the Fayetteville Athletic Club, Kids Fit Fun FACtory will be that any time a child’s behavior jeopardizes the safety of him/herself, others or is acting in a disruptive manner, the child will be removed from the class or program. The Kids FACtory uses “timeout” to encourage good behavior. A child who has been given a “timeout” will be taken out of the group/class participation and must sit alone quietly under staff supervision for 1 minute for each year of age. After the 2nd offense, another timeout will be given. Following a 3rd offense, the child will be sent home for the remainder of the day. The parents and child will need to schedule a conference with the Director to discuss the issue. Continuous or more serious behavior issues may result in suspension/ pending termination from the Kid’s Fit Fun FACtory program. I understand and agree to comply with the Discipline Policy.

Signature(Required)

PHOTOGRAPHY

We will be taking pictures throughout the year to capture the action and adventure of our Kids FACtory programs. I hereby grant permission to Fayetteville Athletic Club to use photographs and/or video of my child(ren) taken during FAC programs, in publications, news releases, online, and in other communications related to the Kid FACtory programs.

SELECT YES OR NO(Required)

Signature(Required)

JUMPSTART PRESCHOOL PAYMENT POLICY

Billing Policy Kids Fit Fun FACtory programs will not admit a participant without Payment Agreement & Registration forms completed by bill payer and registration fees are paid. Each program may have separate and different fees and policies. Program costs are not affected when children cancel or miss days for which they are registered. No substitutions can be made for missed days. Drop in days are not available and children can only attend camp on days which they are registered and paid for. Payment must be made before child can attend camp. Non-payment by due dates will result is forfeit of student’s space in the program. Memberships, private lessons, personal training, and special programs are not included in fees but discounts may apply. FAC member discounts are only applicable if the child holds a “Junior Membership”. Any other discounts must be arranged with Director in writing prior to start of camp. FAC member discounts are void and additional charges will occur if membership is canceled during the time of camp attendance. The non-member rate will be charged to your account retroactively. Changes or cancellations in any registration must be made in writing to the director. This does not guarantee refund or credit of payments that have been made or cancellation any outstanding balances. A $25 fee is charged to any returned payments. Any payments made after a returned payment must be in cash or money order form. Failure to comply with payment will result in suspension of the participant. Non-payment after 60 days of billing date may be subject to collection agencies. Fayetteville Athletic Club accepts cash, money order, checks, Visa, Master Card, Discover, American Express. FAC will not accept any temporary checks. Monthly auto draft and FAC club account charge is not available for weekly programs such as camp, preschool or afterschool. For your convenience, a weekly draft may be set up on credit/debit card only. I agree to abide by the Billing Policy that has been presented to me by the Fayetteville Athletic Club. I hereby acknowledge that all information provided by the undersigned is accurate and that I have read and understand the preceding prior to the signing and agree to all terms outlines above. I understand that the policy may change under the discretion of the billing office and/or director of the program.

Signature(Required)

Name as it appears on your credit card(Required)

Credit card number(Required)

Expiration date(Required)

Credit card type(Required)

VISA

Mastercard

Discover

American Express

CVV(Required)

Enrollment options(Required)

REGISTRATION FEE $50

4-5 YRS FULL TIME $199 Member/ $209 Guest

4-5 YRS 3 DAYS $159 Member/ $169 Guest

4-5 YRS 3 Half Days $99 Members/109 Guest

1-3 YRS FULLTIME $199 Member/ $209 Guest

1-3 YRS 3 DAYS $159 Member/ $169 Guest

1-3 YRS 3 Half Days $99 Members/$109 Guest