NinjAcademy LLC Online Registration

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Welcome to NinjAcademy! All new students are offered a FREE trial and will not be charged until you confirm your enrollment after your trial. Simply select “Yes” under “I would like to trial this class.”

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Referral Information

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Student Last Name*

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Contact #1

Parent/Legal Guardian/Self First Name*

Last Name *

Type*

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Cell # *

Portal Access (your email is your login)

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Confirm Email*

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Contact #2

Parent/Legal Guardian #2 First Name

Last Name

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Cell #

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Student #1

Student's First Name*

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Additional Info

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Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

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Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Medications (Leave blank if NONE)

Primary Doctor

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Student #4 (Show-Hide Details)

Student's First Name*

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Student Gender

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Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Enroll in Classes

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Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

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Registration

Referral Information

Family Information

Where do you live?

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

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Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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