NW Cheer Online Registration

Registration

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Welcome to NW Cheer, home of the SilverStars! Please complete the following registration form.

* 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

Parent/Guardian First Name*

Last Name *

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

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes

Skill Notes

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*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes

Skill Notes

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*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes

Skill Notes

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*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes

Skill Notes

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*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilites*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes

Skill Notes

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

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number