NEO Allstars Online Registration

Registration

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Thank you for choosing N.E.O. All Stars!

* 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*

State*

Zip*

Home or Primary Phone*

Additional Info

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

Health Insurance Carrier*

Contact #1

Primary 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

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Secondary Guardian First Name

Last Name

Type

How can we contact you?

Home Phone *

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Transportation

Special Needs

Allergies*

Medications*

Primary Doctor*

Please take the time to fill your child's medical information. Your first class is a FREE TRIAL CLASS. We will place your athlete in the appropriate class after attending their first class.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Transportation

Special Needs

Allergies*

Medications*

Primary Doctor*

Please take the time to fill your child's medical information. Your first class is a FREE TRIAL CLASS. We will place your athlete in the appropriate class after attending their first class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Transportation

Special Needs

Allergies*

Medications*

Primary Doctor*

Please take the time to fill your child's medical information. Your first class is a FREE TRIAL CLASS. We will place your athlete in the appropriate class after attending their first class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Transportation

Special Needs

Allergies*

Medications*

Primary Doctor*

Please take the time to fill your child's medical information. Your first class is a FREE TRIAL CLASS. We will place your athlete in the appropriate class after attending their first class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School

Transportation

Special Needs

Allergies*

Medications*

Primary Doctor*

Please take the time to fill your child's medical information. Your first class is a FREE TRIAL CLASS. We will place your athlete in the appropriate class after attending their first class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Statement of Consent

I/we the undersigned parent(s) or legal guardian(s) of the registered athlete, do hereby authorize BATR, LLC dba NEO Allstars, and affiliates as agent of the undersigned to consent to any x-ray, examination, anethetic, medical or surgical diagnosis, or treatment and hospital care or service, which is deemed advisable and is to be rendered to said minor, under the general or specific supervision of any physician and surgeon licensed, or the medical staff of a licensed hospital whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.