TEGA Kids Superplex Online Registration

Registration

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Welcome to TEGA Kids Superplex online registration! Please complete the information below for quick and easy enrollment, and click SUBMIT when finished. We review each registration as it comes through, and will apply any registration fees and/or applicable discounts. Credit cards will not be charged until we review your registration!

Please list your child's LEGAL first and last name on the form. Any nicknames can be noted in the comments. Thank you!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info/Authorized Pickups*

Contact #1

Parent/Guardian First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone *

Work #

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

Relationship

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Restrictions or Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Primary Doctor

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Restrictions or Special Needs (leave blank if none)

Allergies (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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Restrictions or Special Needs (leave blank if none)

Allergies (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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Restrictions or Special Needs (leave blank if none)

Allergies (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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Restrictions or Special Needs (leave blank if none)

Allergies (leave blank if none)

Medications (leave blank if none)

Primary Doctor

Enroll in Classes

Select Class

Add Another Student