Pinnacle Prep Academy
2024 - 2025 School Year
Student Registration
Student Athlete Name
*
First Name
Last Name
Gender
*
Please Select
MALE
FEMALE
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Student Athlete Birth Date
*
-
Month
-
Day
Year
Date
Grade Level
*
3rd Grade
4th Grade
5th Grade
6th Grade
Student Athlete Current School
*
Student Athlete Current Grade
*
How Did You Hear About Us?
Pinnacle Coach Name
*
Describe Athlete Level of Play
Submit
Should be Empty: