Log On |  FAQ
HomeCoursesCalendarsMy Account
Notice: Note: If the class on the flyer does not show up in registration then it is full.
Step 1. Create Billing Contact
Step 2. Activate Account
Step 3. Account Activated

Contact Information       Note: Red text indicates required fields.
Billing First Name:
 Billing Last Name:
Address 1:
Address 2:
Country:
  
Prov/State:
  
City: 
  
Postal/Zip Code: 
  
Phone 1: 
  
Phone 2: 
  
Fax: 
  
Email: 
  
Alternate Email:
   
Client #: 
  
 
Account Information
Username:
* We suggest your email address (Min Characters: 5)
Password:
Re-Type Password:  

Password Strength
     

Note: For the best Password Strength rating include:
  • Uppercase and lowercase characters
  • Numbers
  • Symbols
  • Eight or more characters
Extra Information
Sex At Birth:
  Male     Female     X     Decline to Answer  
Birthdate:
      
Medical Information
Family Doctor:
 
Dr. Phone:
 
Medical #:
 
List any medication presently taken:

Do you have any of the following conditions or requirements?:
Allergies:  YesNoEpi-pen Required:  YesNo
Head Injury:  YesNoAthletic Injuries:  YesNo
Assistance Required:  YesNoOther Medical Conditions:  YesNo

Please explain:  

Please list any other ailments that the staff should be aware:

Are there any other reasons why the client should not take part in physical activities?:
Security Check

Captcha Verification  


Next


Contact Us | Rates | Privacy Policy | Refund Policy

© 2024 Univerus Sport and Recreation. All rights reserved.  |    (62)  |  Powered By  Univerus Rec