Crank It Up Registration

The 2019 Fall session of Crank It Up runs from September 5th to October 10th.

Participant's Name *
Participant's Name
Participant's Date of Birth *
Participant's Date of Birth
Participants aged 8-18 are eligible to attend the Crank It Up Program
Membership *
All Crank It Up participants must be members of the JPCA for the duration of the program for insurance purposes.
Please provide the last name associated with the account of the participant's current membership.
Primary Contact's phone number *
Primary Contact's phone number
Primary Contact's Mailing Address *
Primary Contact's Mailing Address
Does the participant carry any medications that the coaches should be aware of (i.e. Epipen, inhaler, glucose, etc.)
Primary Emergency Contact Name *
Primary Emergency Contact Name
Primary Emergency Contact Phone Number *
Primary Emergency Contact Phone Number
Alternate Emergency Contact Name
Alternate Emergency Contact Name
Alternate Emergency Contact Phone Number
Alternate Emergency Contact Phone Number