CORE Kids Academy Online Registration

Registration

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Welcome to CORE Kids Academy! Please provide your information below and click "Submit Registration Information" when finished.

* 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

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from CORE Kids Academy. Standard message and data rates apply. Reply STOP to opt out

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 # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from CORE Kids Academy. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities/Concerns (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

We do require a credit card on file to create an account with us, but it is free to create an account and to be on waitlists.

Please choose one of the fields (ie: Session, Instructor, etc) to begin viewing available classes.

Texting Policies for CORE Kids Academy

By selecting the box "Receive Text Message Notifications" on this form, you are agreeing to our Informed Consent for Text (SMS) Messaging terms, conditions and privacy policy, Informed Consent for Text (SMS) Messaging - DO NOT DELETE

You will give consent to CORE Kids Academy to send occasional text messages regarding class changes, business closings, upcoming events, and account notifications.

If you have questions, please call us at 804-740-0079

For help, reply HELP. Reply STOP to unsubscribe.

Standard messages and data rates may apply.

Please consider adding CORE Kids Academy as a contact, so that our messages will not go to spam.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes or for any other reason.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities/Concerns (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

We do require a credit card on file to create an account with us, but it is free to create an account and to be on waitlists.

Please choose one of the fields (ie: Session, Instructor, etc) to begin viewing available classes.

Texting Policies for CORE Kids Academy

You will give consent to CORE Kids Academy to send occasional text messages regarding class changes, business closings, upcoming events, and account notifications.

If you have questions, please call us at 804-740-0079

For help, reply HELP. Reply STOP to unsubscribe.

Standard messages and data rates may apply.

Please consider adding CORE Kids Academy as a contact, so that our messages will not go to spam.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes or for any other reason.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities/Concerns (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

We do require a credit card on file to create an account with us, but it is free to create an account and to be on waitlists.

Please choose one of the fields (ie: Session, Instructor, etc) to begin viewing available classes.

Texting Policies for CORE Kids Academy

You will give consent to CORE Kids Academy to send occasional text messages regarding class changes, business closings, upcoming events, and account notifications.

If you have questions, please call us at 804-740-0079

For help, reply HELP. Reply STOP to unsubscribe.

Standard messages and data rates may apply.

Please consider adding CORE Kids Academy as a contact, so that our messages will not go to spam.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes or for any other reason.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities/Concerns (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

We do require a credit card on file to create an account with us, but it is free to create an account and to be on waitlists.

Please choose one of the fields (ie: Session, Instructor, etc) to begin viewing available classes.

Texting Policies for CORE Kids Academy

You will give consent to CORE Kids Academy to send occasional text messages regarding class changes, business closings, upcoming events, and account notifications.

If you have questions, please call us at 804-740-0079

For help, reply HELP. Reply STOP to unsubscribe.

Standard messages and data rates may apply.

Please consider adding CORE Kids Academy as a contact, so that our messages will not go to spam.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes or for any other reason.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student Email

School

Grade Level

Disabilities/Concerns (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

We do require a credit card on file to create an account with us, but it is free to create an account and to be on waitlists.

Please choose one of the fields (ie: Session, Instructor, etc) to begin viewing available classes.

Texting Policies for CORE Kids Academy

You will give consent to CORE Kids Academy to send occasional text messages regarding class changes, business closings, upcoming events, and account notifications.

If you have questions, please call us at 804-740-0079

For help, reply HELP. Reply STOP to unsubscribe.

Standard messages and data rates may apply.

Please consider adding CORE Kids Academy as a contact, so that our messages will not go to spam.

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes or for any other reason.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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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*

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

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

Credit Card

Required Policies

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