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Uprise Youth Club Registration
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* Indicates required question
Email
*
Your email
PARENT/GUARDIAN #1 NAME
*
Your answer
PARENT/GUARDIAN #1 PHONE NUMBER
*
Your answer
PARENT#2/GUARDIAN/EMERGENCY PHONE NUMBER
*
Your answer
HOW DID YOU HEAR ABOUT US? (Ex. Google, friend, which school, Facebook, park flyer etc..)
*
Your answer
CHILD'S NAME
*
Your answer
CHILD'S AGE
*
Your answer
GENDER
*
Choose
Female
Male
ALLERGIES, CONDITIONS OR ANYTING ELSE WE NEED TO KNOW?
*
Your answer
2nd CHILD'S NAME
Your answer
2nd CHILD"S AGE
Your answer
GENDER
Choose
Female
Male
ALLERGIES, CONDITIONS OR ANYTING ELSE WE NEED TO KNOW?
Your answer
LIST OF APPROVED INDIVIDUALS TO PICK YOUR CHILD UP.
*
Your answer
SELECT PROGRAM/S OF INTEREST TO GET MORE INFORMATION
*
SPORTS POD/PLAY GROUPS
PRIVATE LESSONS
CHARACTER BUILDING (RUN CLUB)
BIRTHDAY PARTY
SUMMER POD
Other:
Required
IS THERE FAMILY, OR FRIENDS WHOM YOU WOULD LIKE THE CHILD TO BE IN THE SAME CLASS WITH WHO ARE ALSO ENROLLING?
*
Your answer
TODAYS DATE
*
MM
/
DD
/
YYYY
Submit
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