ActivStars Kansas Pre Reg Registration

User Registration

Parent Name*

Username*

Password*

Student(s)

Student Name*

Birthday*

/ /

Other Information

Address*

City*

State*

Zip*

Email* Primary method of Communication

Primary Channel to receive important notifications

Secondary Email

Cell/Communication #*

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By checking this box, I agree to receive recurring auto dialed phone calls or text messages from or on behalf of ACTIVSTARS the telephone number provided, including messages that are based on my phone’s location. I understand that consent is not a condition of any purchase. Messages and data rates may apply. Would you like to receive calls/text messages regarding important program alerts such as moves, cancels, promotions, and other important reminders?

Ok to receive SMS Text notifications

Alternate Guardian #

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How did you hear about us*

Other referral

If other, please let us know where did you hear about us from.

*required field