Exceptional Athletics Online Registration

Registration

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EXA Sports Registration

* 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

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Cell # * Receive Text Message Notifications

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?

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

AAU# @www.AAUsports.org

AAU expiration date

You may begin classes on your next schedule class date (ex: your class is scheduled for Mondays, you may begin Monday).

Gymnasts please wear a Leo or athletic clothes to class. Hair pulled back, no jewelry. Cheerleaders wear athletic clothes, cheer shoes, hair pulled back. No jewelry.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

AAU# @www.AAUsports.org

AAU expiration date

You may begin classes on your next schedule class date (ex: your class is scheduled for Mondays, you may begin Monday).

Gymnasts please wear a Leo or athletic clothes to class. Hair pulled back, no jewelry. Cheerleaders wear athletic clothes, cheer shoes, hair pulled back. No jewelry.

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

AAU# @www.AAUsports.org

AAU expiration date

You may begin classes on your next schedule class date (ex: your class is scheduled for Mondays, you may begin Monday).

Gymnasts please wear a Leo or athletic clothes to class. Hair pulled back, no jewelry. Cheerleaders wear athletic clothes, cheer shoes, hair pulled back. No jewelry.

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

AAU# @www.AAUsports.org

AAU expiration date

You may begin classes on your next schedule class date (ex: your class is scheduled for Mondays, you may begin Monday).

Gymnasts please wear a Leo or athletic clothes to class. Hair pulled back, no jewelry. Cheerleaders wear athletic clothes, cheer shoes, hair pulled back. No jewelry.

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

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

AAU# @www.AAUsports.org

AAU expiration date

You may begin classes on your next schedule class date (ex: your class is scheduled for Mondays, you may begin Monday).

Gymnasts please wear a Leo or athletic clothes to class. Hair pulled back, no jewelry. Cheerleaders wear athletic clothes, cheer shoes, hair pulled back. No jewelry.

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*

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?

Who is your employer?

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

(Show-Hide Details)