Program Application

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Program Application

Applicant Information
School or Organization Name
Address
Street Address Address Line 2 City State ZIP Code
School/Organization Phone Number
School/Organization Website
School District
Network/Affiliation
Principal/Director Name
First Last
Email
Fit Kids Liaison*
First Last
Note: the Fit Kids Liaison will serve as the primary contact for all communication related to the Fit Kids program. This includes tasks such as scheduling site visits (if applicable), submitting program data and feedback, and addressing general program questions as they arise.
Liaison Title/Role
Liaison Direct Phone*
Liaison Email*
Who will implement the Fit Kids program at your school site? (Check all that apply.)
- PE Teacher
- Athletic Director
- Classroom Teachers
- Volunteer
How did you hear about Fit Kids?
- Currently using Fit Kids Program
- My school/organization used Fit Kids last school year
- Internet Search
- Referral
If Referral, who can we thank?
Program Request Options (Check all that apply)*
- Purchase a 1 year Program Membership for $3,500; includes curriculum and equipment. Program may be converted to an Online Membership upon renewal.
- Purchase a 1 year Online Membership for $1,000; curriculum only.
- Enlist Fit Kids’ guidance to help fundraise the $3,500 fee.
- Enlist Fit Kids’ guidance to help fundraise the $1,000 fee.
- Join Fit Kids’ wait list until a free program becomes available.
School/Organization Info & Demographics
Please list the percentage of students at your site for each category below.
White or Caucasian Hispanic or Latino Black or African American Native American or Alaskan Native Asian or Pacific Islander Other
Percentages should add up to 100%.
What percentage of the children in your school/organization qualify for free-or-reduced lunch?
Please select all the grade levels your school/organizations serves.
- TK
- K
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
- 7th
- 8th
Please select all the grade levels that will participate in Fit Kids.
- TK
- K
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
- 7th
- 8th
List the number of students that will participate in Fit Kids. Please use whole numbers.
Short Answer Questions
1. When will your school/organization use Fit Kids? (Check all that apply.)
- During the school day
- After the school day
- Summer
2. Does your site have a PE program?
- Yes
- No
3. Does your site have an after school sports program?
- Yes
- No
4. Do your students participate in any structured physical fitness activities after school?
- Yes
- No
If Yes, explain:
5. Please explain the need for the Fit Kids program for your school/organization.
6. Please tell us how the Fit Kids Program will fit into your existing health and fitness plans.
Disclaimer and Signature
Consent*
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application may result in ineligibility to receive the program.
Printed Name*
Title/Role*
Date*
MM slash DD slash YYYY

Fit Kids Foundation | 1143 Crane Street, Unit 203 Menlo Park, CA 94025 | 650-299-1599

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Program Application

Applicant Information

School/Organization Info & Demographics

Short Answer Questions

Disclaimer and Signature