Signup for Class | IMPACT Personal Safety

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Please complete the form below. We will process your request and respond with an email or phone call. Be sure your email address and phone numbers are correct. For our rates and discounts, click here.

Please note registration and payment arrangements MUST be completed by 3pm on the last business day before the class. No walk-ins.

If you are registering for our Kids Class, please enter parent info in the form below and indicate the name(s) and age(s) of the kid(s) in the Questions/Comments box below. Thank you!

IMPACT Class*
Empowered Family - Names & Ages*
Names and Ages of students/family members participating in the class
Name*
First Last
Please enter the parent name if enrolling children in the kids class.
Email*
Mobile Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How Did You Hear About Us?*
Number of children you want to enroll
Child 1 - Name
First Last
Child 1- Age
Child 2 - name
First Last
Child 2 - Age
Child 3 - Name
First Last
Child 3 - Age
Child 4 - Name
First Last
Child 4 - Age
Child 5 - Name
First Last
Child 5 - Age
Comments/Questions
If you have more than 5 children to enroll to the kids class please enter their names and ages here.

Have a Group or Special Class Request?

Click here for Private Classes