Child Student Intake Form At Spirit of the Heart we are committed to helping each student reach their individual training goals. Please fill out this form completely, so we can get to know your child better in order to serve them to the best of our ability.. Date Kids First Name* Kids Age* Birthdate* Parent's Full Name* Phone* Email* Address* 2nd Parent's Name 2nd Parent's Email 2nd Parent's Phone 2nd Parent's Address, if Different Emergency Contact Name * Emergency Contact Phone* Allergies / Other Concerns* How Did You Heart About Us?* Friend Family Member Google Bing Yahoo Facebook Instagram Drive By I Am a Returning Student What Benefits Would You Like Your Child to Receive From Your Training?* Fun Self-Regulation Physical Conditioning Healing from Past Trauma (Share More in Space Below) Better Concentration Making Friends Tuning into Oneself Self-Acceptance Confidence Anger Management Inner Calm Self-Defense Other Tell Us More... What are Your Child's Strengths? What School Does Your Child Go To? Homeschooling?* What Are Your Child's Other Interests and Hobbies? Alternative Pick-Up Person's Name Alternative Pick Up Phone Alternative Pick Up Person #2 Name Alternative Pick Up #2 Phone Submit
