Future Fixers Program Pre Registration Form

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Future Fixers Program Pre Registration Form

uBreakiFix by Asurion

364 Garrisonville Rd

Ste 123,

Stafford, VA 22554

Child's First & Last Name *

Child's Date of Birth *

AAAA

Parent's First & Last Name *

Parent's Email *

Parent's Cell Number *

What is your child's T-Shirt size? *

Does your child have any experience with eletronic repairs? *

Child's Dietary restrictions *

Do you live in Stafford? *

I would like my child to attend the follow class: *

March 23 - April 20

April 27 - May 25

June 1 - June 29

July 6 - August 3

August 10 - Sepember 7

September 14 - October 12

October 19 - November 16

2025 Schedule Pending

Obligatorio

Please email me the complete registration package. *

I understand that I will have to pay a $650 Program Fee once registered. $700 for kids outside of stafford. *

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