Impact Elite Athletics Online Registration

Registration

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Welcome to Impact Elite Athletics! Please complete the following registration form. The process is simple for both new and returning members. You'll get access to your own private account that will enable you easily complete registration and sign up for classes & events, see your children's progress, maintain your own contact information, and more. We look forward to having you join the Impact Elite Athletics and are excited for another great season!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone

Work #

Cell # *

By providing your phone number and checking this box, you agree to receive transactional and informational SMS messages from Impact Elite Athletics. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out and HELP for help.

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Special Needs (Type NONE if NONE)*

Allergies (Type NONE if NONE)*

Medications (Type NONE if NONE)*

Primary Doctor*

Immunization Notes

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Special Needs (Type NONE if NONE)*

Allergies (Type NONE if NONE)*

Medications (Type NONE if NONE)*

Primary Doctor*

Immunization Notes

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Special Needs (Type NONE if NONE)*

Allergies (Type NONE if NONE)*

Medications (Type NONE if NONE)*

Primary Doctor*

Immunization Notes

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Special Needs (Type NONE if NONE)*

Allergies (Type NONE if NONE)*

Medications (Type NONE if NONE)*

Primary Doctor*

Immunization Notes

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

School

Grade Level

Special Needs (Type NONE if NONE)*

Allergies (Type NONE if NONE)*

Medications (Type NONE if NONE)*

Primary Doctor*

Immunization Notes

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Membership Type*

Please fill out ONE of the following Payment Methods

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Required Policies

(Show-Hide Details)