Force Elite Academy Online Registration

Registration

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Welcome to Force Elite Academy! Please complete the following registration form. If you have any questions please feel free to contact us via email at info@forceeliteacademy.com.au or call us on (08) 8164 3972

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Account Information

Last Name*

Where do you live?

Home Address*

City*

State*

Postcode*

Additional Info

Emergency Contact Info (Name & Contact)*

Contact #1

Account Holder First Name*

Last Name *

Relationship to Athlete*

How Can We Contact You?

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*

Gender*

Birth Date*

Cell #

Additional Info

Athlete Email (if applicable)

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Current or Previous Injuries

If you are not sure which class/es to select, contact us via email or call our friendly reception staff to assist.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Athlete Email (if applicable)

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Current or Previous Injuries

If you are not sure which class/es to select, contact us via email or call our friendly reception staff to assist.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Athlete Email (if applicable)

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Current or Previous Injuries

If you are not sure which class/es to select, contact us via email or call our friendly reception staff to assist.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Athlete Email (if applicable)

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Current or Previous Injuries

If you are not sure which class/es to select, contact us via email or call our friendly reception staff to assist.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Athlete Email (if applicable)

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Current or Previous Injuries

If you are not sure which class/es to select, contact us via email or call our friendly reception staff to assist.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Account 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

Required Policies

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