Please know that this is only the registration form. You must still log into your jackrabbit account and click on the blue "Make a Payment" button in order to complete this transaction. The event is open to approximately 45 students and 12 adults.
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Name, Number, Relationship
(Not Contact #1 or #2)*
Students entered below will be added to your family's account
Lunch choices: Pasta Primavera; Spaghetti & Meatballs; Cheese Pizza; Salad w/grilled Chicken; Chicken Hero; Chicken Parmigiana*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:  
Name as it appears on card:
Card Expiration Month:   Exp Year:
Address Line 1: Address Line 2:
City: State: Zip: