COMPLETE THE FORM BELOW


Birthdate:
Parent Name:




Preferred Location:
Session:
Physician Name:
Physician Practice, Group or Hospital:
Reasons for Enrollment:
Goals You Would Like To See Achieved:
How did you hear about ProActive Kids?:
how to register


2019 sessions are under development, but you can still sign up. when the schedule is available, you will receive in your email.

SIMPLY COMPLETE THE FORM TO THE RIGHT TO REGISTER YOUR CHILD.  IF YOU ARE REGISTERING MULTIPLE PARTICIPANTS, PLEASE USE A DIFFERENT FORM FOR EACH CHILD. YOU WILL RECEIVE AN EMAIL WITHIN 10 MINUTES OF REGISTERING TO CONFIRM WE RECEIVED YOUR REGISTRATION.  IF YOU HAVE ANY QUESTIONS ABOUT THE PROGRAM, PLEASE VISIT OUR FAQ PAGE.

ONCE YOU register, YOU ARE AUTOMATICALLY signed up FOR THE PROGRAM. YOU DO NOT NEED A FURTHER NOTE OF ACCEPTANCE. PROACTIVE KIDS DOES HAVE THE RIGHT TO REMOVE YOU FROM THE PROGRAM IF YOU DO NOT FIT AGE OR WEIGHT CRITERIa (see below).

PLEASE VISIT THE LOCATION PAGE TO KNOW WHEN THE NEXT SESSION IS FOR YOUR DESIRED LOCATION. SESSIONS AND LOCATIONS DO VARY, SO PLEASE LOOK BEFORE YOU REGISTER. 

NOTE: EL PROGRAMA AUN NO SE OFRECE EN ESPAÑOL.



CRITERIA FOR REGISTRATION

1. YOUR CHILD MUST BE STRUGGLING WITH UNHEALTHY WEIGHT. THIS IS CLASSIFIED BY BEING IN THE 85TH PERCENTILE AND ABOVE IN THEIR BMI. NOT SURE IF YOUR CHILD QUALIFIES, VISIT THIS WEBSITE FOR A GENERAL CALCULATION OF BMI  AND BMI PERCENTILE CHART USING YOUR CHILD'S MEASUREMENTS. IF YOU NEED HELP, JUST GIVE US A CALL AT 630-681-1558.

2. CHILDREN MUST BE BETWEEN THE AGES OF 8 AND 14.

THE PROGRAM IS OFFERED FREE BY THE HOSPITALS WHO GENEROUSLY OFFER THE PROGRAM IN THEIR COMMUNITIES. (PAK DOES NOT REQUIRE ANY PROOF OF INSURANCE OR MEDICAL COVERAGE).

IF YOU HAVE ANY QUESTIONS OR PROBLEMS WITH REGISTRATION, PLEASE CALL 630-681-1558 OR EMAIL INFO@PROACTIVEKIDS.ORG.

PLEASE ENSURE YOU ENTER THE CORRECT EMAIL ADDRESS. THAT IS HOW WE GET IN TOUCH WITH YOU.