Membership

The E Street Membership includes unlimited access to the facility during open hours, unlimited access to fitness classes, and reduced program fees for programs that require an additional fee.

	Price per Month
Youth/Young Adult (12-23 Years)	$21.20
Adult (24-61 Years)	$41.34
Senior (62 & Older)	$37.10
Family	$68.90
Single Parent Family	$55.65
2 Person Family (Must Be In The Same Household)	$58.30

Financial Assistance is available for those who qualify.

Registration

Child's Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

School child attends(Required)

Teacher(Required)

Grade level child will be in during the 2021-2022 school year(Required)

Mother/Guardian Information

Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Employer

Work Phone

Emergency Contact(Required)

Authorized to Pick Up(Required)

Father/Guardian Information

Name

First Last

Date

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer

Work Phone

Emergency Contact

Authorized to Pick Up

Emergency Contacts and/or authorized pickups (other than parents):

Contact 1

Name

First Last

Date of Birth

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Driver's License #

Emergency Contact

Authorized to Pick Up

Contact 2

Name

First Last

Date of Birth

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Drivers License #

Emergency Contact

Authorized to Pick Up

Contact 3

Name

First Last

Date of Birth

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Drivers License #

Emergency Contact

Authorized to Pick Up

Camp Information

Camp Registration

Full Week Registration ($125)

3/17/22 Thursday - Volleyball ($25)

3/18/22 Friday - Zumba ($25)

3/21/22 Monday - Basketball, Yoga at 10am ($25)

3/22/22 Tuesday - Tennis ($25)

3/23/22 Wednesday - Football/Soccer, Yoga at 10am ($25)

3/24/22 Thursday - Track & Field Day ($25)

3/25/22 Friday - BBQ & Basketball ($25)

Agree to Complete Registration(Required)

I agree to visit the E Street Community Center to finish the registration and complete payment.

Membership

Registration

Mother/Guardian Information

Father/Guardian Information

Emergency Contacts and/or authorized pickups (other than parents):

Contact 1

Contact 2

Contact 3

Camp Information

CONTACT

Hours