Registration

Let's celebrate community through our RISE Events! Disney Jr. LIVE is pure for all ages! Mickey is getting ready for the biggest playdate ever at the Clubhouse with all his favorite pals including Minnie and Goofy, the Puppy Dog Pals, Ginny and Bitsy from "Super Kitties" and Ariel from "Disney Jr.'s Ariel".
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)*
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Payment Information
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Transportation
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Chaperone Age Requirement
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Disney Jr. LIVE@DPAC Waiver
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Debit Authorization
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Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*