East Celebrity Elite Online Registration

Registration

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There is an annual $60 registration fee assessed each calendar year. This fee is waived for during tryout season (as you pay it for tryout registration) and it is also waived sometimes for a single class/clinic registration.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family (please use athlete last name) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

Contact #1

Contact #1 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

Contact #2

Contact #2 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*

Cell #

Additional Info

Student Email*

T-Shirt Size*

Allergies*

Medications*

Primary Doctor*

T Shirt/Sweatshirt Size*

Thank you for registering your athlete. Once you have created your portal account, you may use it to register for any class, private lesson, or clinic!

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

Allergies*

Medications*

Primary Doctor*

T Shirt/Sweatshirt Size*

Thank you for registering your athlete. Once you have created your portal account, you may use it to register for any class, private lesson, or clinic!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

Allergies*

Medications*

Primary Doctor*

T Shirt/Sweatshirt Size*

Thank you for registering your athlete. Once you have created your portal account, you may use it to register for any class, private lesson, or clinic!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

Allergies*

Medications*

Primary Doctor*

T Shirt/Sweatshirt Size*

Thank you for registering your athlete. Once you have created your portal account, you may use it to register for any class, private lesson, or clinic!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

Allergies*

Medications*

Primary Doctor*

T Shirt/Sweatshirt Size*

Thank you for registering your athlete. Once you have created your portal account, you may use it to register for any class, private lesson, or clinic!

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?

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)