Once you submit your household information form, registration staff will review it to confirm residency and notify you via email within one business day that your account has been activated.

Please use the applicable abbreviations, shown here, when entering your address (Avenue = Ave, Boulevard = Blvd, Circle = Cir, Court = Ct, Drive = Dr, Highway = Hwy, Lane = Ln, Place = Pl, Road = Rd, Street = St, Terrace = Ter, and Way = Way). Please do NOT use punctuation. Thank you!

Please complete the following information about your household

* REQUIRED DATA
User Name (Your Email Address) (up to 50 chars)
Password (up to 50 chars)
Retype to Confirm
Head of Household Information
Name of Primary Guardian (First)
Name of Primary Guardian (Last)
Date of Birth (mm/dd/yyyy)
Gender
Secondary Guardian Information
Name of Secondary Guardian (First)
Name of Primary Guardian (Last)
Gender
Date of Birth (mm/dd/yyyy)
Primary Guardian Email and Phone
Primary Email Address
Retype to Confirm Email Address
Home Phone w/ area code (xxx)xxx-xxxx
Cell Phone w/ area code (xxx)xxx-xxxx
Work Phone w/ area code (xxx)xxx-xxxx
Work Extension
Secondary Guardian Email and Phone
Secondary Guardian Email Address
Cell Phone w/ area code (xxx)xxx-xxxx
Work Phone w/ area code (xxx)xxx-xxxx
Work Extension
Address Information
Street Address Line 1
Street Address Line 2
City
State/Province
Postal/Zip Code
Emergency Contact/Child Pick-up Information
Name of Emergency Contact (First) Name of Emergency Contact (Last) Contact Phone w/ area code Relationship

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* REQUIRED DATA

Important: If any of your children have a severe allergy or medical condition diagnosed by a doctor, or require an NSSRA Companion, please contact the Main Registration Office at (847) 835-3030. Thank you.

	Name of Emergency Contact (First)	Name of Emergency Contact (Last)	Contact Phone w/ area code	Relationship
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