Artistic Sports Academy Plus Online Registration

Registration

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All initial and one-time fees will be charged to your credit card as soon as registrations are received unless otherwise arranged with our office staff. These fees include, but are not limited to: Yearly Membership Fees, First Month's Tuition, Birthday Party Deposit, Summer Camps, Holiday Parties and other special events.

* denotes required fields

Referral Information

How did you hear about us?*

Family Information

Family Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Parent / Guardian 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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent / Guardian 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*

Additional Info

Student Email

T-Shirt Size

Special Needs/Disabilities

Allergies/Medical Conditions (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

*Please note by selecting multiple classes you will be charged for EACH class you register for, unless you are on the "wait list" for a class. You will not be charged for wait list classes until an opening becomes available. We will notify you by phone/email when a spot opens up.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Special Needs/Disabilities

Allergies/Medical Conditions (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Special Needs/Disabilities

Allergies/Medical Conditions (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Special Needs/Disabilities

Allergies/Medical Conditions (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

T-Shirt Size

Special Needs/Disabilities

Allergies/Medical Conditions (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Account Information

Payment Method after First Month*

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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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)

Who is your employer?

Contact #2

How can we contact you?

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)

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Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies

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