Registration
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Please complete the below to purchase a $100 gift certificate.
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medical conditions that we should be aware of (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medical conditions that we should be aware of (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medical conditions that we should be aware of (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medical conditions that we should be aware of (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies/Medical conditions that we should be aware of (Leave blank if NONE):
Questions/Options:
Option 1: I would like the gift certificate amount automatically applied to an existing students' account. (On-line Gift Certificate)
*
Yes
No
Students name IF Option 1 chosen.
Option 2: I would like a negotiable gift certificate mailed to my address. Note: The gift certificate must be returned to Action Kids to be redeemed. (Traditional Gift Certificate)
*
Yes
No
Additional Information:
Non refundable
(Show-Hide Details)
Gift certificates are non-refundable, but are transferable to any student.
I've read the above and agree.
Payment
(Show-Hide Details)
The gift certificate will be finalized when payment has been received. We accept Visa, Mastercard and Discover, as well as ACH. If the payment on file is declined, you will be notified via email.
I've read the above and agree.
On-line Only Gift Certificate Choice
(Show-Hide Details)
The On-line only Gift Certificate will be applied directly to the account of the child/family of your choice for their immediate use once the sale is finalized.
I've read the above and agree.
Traditional Gift Certificate Choice
(Show-Hide Details)
The Traditional gift certificate will be mailed to your address once the sale is finalized. The gift certificate will have a monetary value in the same amount chosen. The gift certificate must be returned to Action Kids to be redeemed and cannot be used through the parent portal as a payment method. Action Kids staff will apply the payment to the account once the gift certificate is returned. Lost gift certificates will not be replaced.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
*
Add Credit Card
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