Register Online

Use this form to register for Ignite programs. Please be sure and indicate which program you are registering for.

Confidentiality: All information given to the Club is confidential. Some is used for statistical reference only and is necessary for us to receive the proper funding for our Club and programs. We appreciate your cooperation and understanding. Failure to complete all sections will result in an incomplete application.

Membership Form

1Program Selection

2Child Info

3Parent/Guardian

4Photography and Video Release

5Parent Release Form

Program Selection

Available Programs(Required)

After School

Summer Camp

Check all that apply.

Child Information (Member)

Name(Required)

First Middle Last

Birthday(Required)

Age(Required)

Gender(Required)

Ethnicity

School Name(Required)

Does your child have any disabilities or special needs. If yes, please list:(Required)

Yes

Please list any disabilities or special needs.(Required)

Does your child have any allergies. If yes, please list:(Required)

Yes

Please list any allergies.(Required)

Mailing Address(Required)

Street Address City State ZIP Code

Physical Address

Same as mailing address above

Primary Contact (Parent/Guardian)

Name(Required)

First Last

Relationship(Required)

Cell Phone

Mailing Address

Same as child's

Street Address City State ZIP Code

Secondary Contact (Parent/Guardian)

Name(Required)

First Last

Relationship(Required)

Cell Phone(Required)

Mailing Address

Same as child's

Street Address City State ZIP Code

Emergency Contact

Name(Required)

First Last

Cell Phone(Required)

Relationship(Required)

Name(Required)

First Last

Cell Phone(Required)

Relationship(Required)

Other Authorized for Student Pick Up:

Name(Required)

First Last

Cell Phone(Required)

Relationship(Required)

Name(Required)

First Last

Cell Phone(Required)

Relationship(Required)

View Pricing

Register Online

Membership Form

Program Selection

Child Information (Member)

Primary Contact (Parent/Guardian)

Secondary Contact (Parent/Guardian)

Emergency Contact

Other Authorized for Student Pick Up:

Photography and Video Release

Join the Ignite Family

Make a Difference

Come Visit Us

903-717-8626