Brooklyn Ninja Academy Online Registration

Registration

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Welcome to Brooklyn Ninja! Please complete the following registration form. YOU (parent/contact) and STUDENT (kid or self for adults). ADULT PARTICIPANTS: Enter yourself as both student and contact. Please use an ACTIVE EMAIL ADDRESS. We communicate important messages via email about our classes!

* 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)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If your class is not pre-filled, please click on the SEARCH button below, then choose the class.

FOR DROP IN CLASSES, ADULTS, or PARTIES, click on EVENTS.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If your class is not pre-filled, please click on the SEARCH button below, then choose the class.

FOR DROP IN CLASSES, ADULTS, or PARTIES, click on EVENTS.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If your class is not pre-filled, please click on the SEARCH button below, then choose the class.

FOR DROP IN CLASSES, ADULTS, or PARTIES, click on EVENTS.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If your class is not pre-filled, please click on the SEARCH button below, then choose the class.

FOR DROP IN CLASSES, ADULTS, or PARTIES, click on EVENTS.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

If your class is not pre-filled, please click on the SEARCH button below, then choose the class.

FOR DROP IN CLASSES, ADULTS, or PARTIES, click on EVENTS.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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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)

Contact #2

How can we contact you?

Student #1

Enroll in Classes

Student #2 (Show-Hide Details)

Enroll in Classes

Student #3 (Show-Hide Details)

Enroll in Classes

Student #4 (Show-Hide Details)

Enroll in Classes

Student #5 (Show-Hide Details)

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)