Registration

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*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Student's Name*
Parent or Guardian Name*
Parent or Guardian Phone #*
Emergency Contact Name and Phone # (in addition to parent listed)*
Student Age*
Would your child like cheese or pepperoni pizza?*
Does your student have any medical condition or food allergies that we should be aware of?*
 
Additional Information:
 
Liability Waiver
  (Show-Hide Details)
I've read the above and agree.
 
Covid Agreement
  (Show-Hide Details)
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Please fill out ONE of the following Payment Methods.
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:
 
 
eCheck/Bank Draft:
Bank Name:
Bank Routing Number: (9-digit number)
Your Account Name: (Your name on your bank statement)
Your Account Type:   Account Number: