Update Contact Information

Parent Name (First and Last)
*
Parent Name (First and Last)
Student's Name (First and Last)
*
Birthdate
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2nd Student's Name (First and Last)
Birthdate
3rd Student's Name (First and Last)
Birthdate
Address
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- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Email Address
*
Any additional email addresses you want information sent to (such as a spouse's email)?
Cell Phone Number
*
Any additional cell phone numbers you want information sent to (such as a spouse's cell phone number)?
May we send you texts containing studio information?
*

Yes
No
Emergency Contact Name
*
Emergency Contact Number
*
Emergency Contact Name
*
Emergency Contact Number
*
Please enter any medical information you would like to include:
Please enter any medication you want us to be aware of:
Please check the boxes below if you agree:
*

I have read the studio policies and procedures and I agree to adhere to all policies and procedures listed below.
I an in agreement with the media policy as spelled out in the policies and procedures listed below.
By typing your name below, you are acknowledging that you have read and agree to the studio policies listed below. Printed copies of the policies are available at the studio upon request. Type your first and last name as your signature:
*
Date Signed
*
Please enter any additional information you were not able to fill in above:

If you need to change your name or your email address (the one you use to login) on your SportsEngine Motion account, you will need to login and make the changes yourself. We do not have the ability to change these 2 pieces of information.