Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

For guardians of youth 13-18yrs: Your child is to complete a registration account. You can create your own accounts as well and we can link them to your child. This allows me to correspond with all parties if your child gives permission.
For guardians of youth 12yrs and under: Complete Client section as your child. Please register other guardians with a separate account.

Client Type

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )


( optional )
( optional )






(optional) (required)
( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details




Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )