Alpine Education Services Online Registration

Registration

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We're excited to have you join our Elite Learning Family!

Please make sure all registration info is accurate and current. Registration must be completed 48–72 hours before your child(ren)'s start date. For questions or support, contact us at support@elitelearning.org or (281) 888-5233. Thank you for choosing Elite Learning — we’re excited to welcome your child(ren)'s and look forward to a great year ahead!

* denotes required fields

Referral Information

How did you hear about us?

Family Information

Parent/Guardians Last Name*

Where do you live?

Home Address*

City*

State*

Zip Code*

Primary Phone*

Additional Info

Emergency Contact: In case parent cannot be reached ( Full Name, Phone Number, Relation to Child)*

Health Insurance Provider*

Military Personnel? (Y/N)*

School Staff? (Y/N) *

Free/Reduced Lunch?(Y/N)*

Media Release Permission(Y/N)*

Contact #1

Primary Parent/Guardian First Name*

Last Name *

Relation to child*

How Can We Contact You?

Home Phone

Work # *

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Alpine Education Services. Standard message and data rates apply. Reply STOP to opt out

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*

Relation to child*

How can we contact you?

Home Phone

Work # *

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Alpine Education Services. Standard message and data rates apply. Reply STOP to opt out

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Liability Waiver

I've read the above and agree.

Parent Handbook

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name* May 9, 2025

Questions or Concerns

Comments

Payment Information

Account Information

ePayment Schedule*

Membership Type*

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 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)

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 and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)