Midwest Training and Ice Center Online Registration

Registration

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Please completely fill out each section of the registration. *** IF YOU ARE ATTENDING ONLY OPEN SKATE/OPEN GYM, PLEASE COMPLETE AS MUCH AS YOU CAN AND GIVE US A CALL TO CONFIRM ENROLLMENT*** Carefully read through each of the policies. Keep in my mind that by completing this registration, and entering your full name below you agree to its entirety. Be sure to include valid credit card information, as this is required.

* denotes required fields

Referral Information

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Drivers License Number

How did you hear about us?

Auto Pay Date: 1st, 10th, 15th

Contact #1

Contact #1 First Name*

Last Name *

Type*

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

Type

How can we contact you?

Home Phone

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

Disabilities

Special Needs

Allergies

Medications

Please choose from the below categories of classes. Most classes are available for online registration, however, classes with pre-requisites or by invite only must be done at Midwest.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Please choose from the below categories of classes. Most classes are available for online registration, however, classes with pre-requisites or by invite only must be done at Midwest.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Please choose from the below categories of classes. Most classes are available for online registration, however, classes with pre-requisites or by invite only must be done at Midwest.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Please choose from the below categories of classes. Most classes are available for online registration, however, classes with pre-requisites or by invite only must be done at Midwest.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Please choose from the below categories of classes. Most classes are available for online registration, however, classes with pre-requisites or by invite only must be done at Midwest.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

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

Account Information

Credit Card

Required Policies

(Show-Hide Details)