EXTREME ATHLETICS Online Registration

Registration

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Welcome to EXTREME ATHLETICS! We offer a variety of programs for all ages and levels. Please complete the following registration form to get started. Please note: You do not have to fill in the credit card information if you do not wish to keep it on file, simply leave blank and submit your registration :)

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Primary Phone*

Additional Info

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

Contact #1

Contact #1 First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Health Card #*

Health Card Expiry*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Health Card #*

Health Card Expiry*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Health Card #*

Health Card Expiry*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Health Card #*

Health Card Expiry*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Allergies (Leave blank if NONE)

Health Card #*

Health Card Expiry*

Please click on the Search button below, then choose the class.

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

Country

City

Province

Postal Code

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)

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)