Welcome!
Please complete the form below to register automagically. Once registered, you’ll start receiving notifications about all our upcoming events and programs. You’ll also receive an email with your child's Positive Chocies with Actions membership card, which they will use to sign into each class of the cohort selected.
Cohort Selection
*
Please Select
March 15 - May 17, 2025
June 21 - August 23, 2025
September 20 - December 20, 2025
Parent Registration
Parent Name
*
First Name
Last Name
Parent Date of Birth
*
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
PA
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Email Opt-In
Please keep me in the loop with news and upcoming events from Elegance Xtreme, Inc․
Media Release Statement
I hereby grant permission to EleganceXtreme, Inc. to use my photograph and likeness in all forms of media for any lawful purpose, including publicity, illustration, advertising, and web content.
How did you hear about us?
*
Word of mouth
Social media
Email
Other
Child Information
Child Name
*
First Name
Last Name
Child Gender
*
Male
Female
Child Date of Birth
*
-
Month
-
Day
Year
Date
Child School
*
Child Dietary Restrictions
Does your child have access to a laptop or tablet with reliable internet access?
*
Yes
No
Child Photo
*
Browse Files
Drag and drop files here
Choose a file
Only jpg, jpeg, png, gif, and heic files are accepted. Please make sure the image is clear and bright and your child's face is centered, as it will be placed on your child's program ID card.
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of
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