East Celebrity Elite Online Registration

Registration

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Welcome to the Online Portal Registration for East Celebrity Elite Hingham! Please complete the following registration form in its entirety and note that this form is optimized for use on a computer rather than a mobile device. If you run into issues while completing this form on a mobile device, please re-try on a computer. All athletes who attend ECE must fill this out.

* denotes required fields

Information

Athlete Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Additional Info

Emergency Contact Information*

Health Insurance Carrier and Policy Number*

Contact #1

Parent/Guardian 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

Secondary Parent/Guardian 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*

Additional Info

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Please fill out the entire registration form, pick the event / class checkout and pay. If no payment is needed for the class you do not have to submit a payment!

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Please fill out the entire registration form, pick the event / class checkout and pay. If no payment is needed for the class you do not have to submit a payment!

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Please fill out the entire registration form, pick the event / class checkout and pay. If no payment is needed for the class you do not have to submit a payment!

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Please fill out the entire registration form, pick the event / class checkout and pay. If no payment is needed for the class you do not have to submit a payment!

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Please fill out the entire registration form, pick the event / class checkout and pay. If no payment is needed for the class you do not have to submit a payment!

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

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

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)