Impact XP

Register a Gamer

Competition is Saturdays 10:00 AM–1:00 PM at Dellwood Rec Center (Dellwood, MO 63136). The season starts Saturday, October 24, 2026.

View the Impact XP flyer

A parent or legal guardian must complete this form. Every registration is reviewed by staff before a gamer is enrolled.

Student first nameStudent last nameDate of birthGradeSchoolTeam or partner site (optional)Parent / guardian full nameRelationship to studentParent / guardian emailParent / guardian phoneEmergency contact nameEmergency contact phone

Parent / guardian consent

Your contact information and your child's clothing size will be shared with your child's assigned coach and team contact for team communication.

I give permission for my child to participate in the Impact XP Esports Development Program. *The information I provided is accurate to the best of my knowledge. *In an emergency, I authorize New Avenue Inc. staff to seek medical care for my child if I cannot be reached. *My child and I agree to follow Impact XP rules and the New Avenue code of conduct. *New Avenue Inc. may use photos or video of my child in program materials (optional).

Signature — type your full name

Already received our Jotform registration link? It still works — open the Jotform.