Registration
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C.I.T.Y. Club's Winter Camp is the perfect way to spend your holiday break! Our gymnastics and scholastics approach to camp will keep everyone challenged physically and mentally through a combination of gymnastics training, focus-building games, arts and crafts, and open play! Sign up today- space is limited! ****PLEASE NOTE**** CAMP TUITION WILL BE MANUALLY ADJUSTED BY STAFF PRIOR TO PROCESSING YOUR CREDIT CARD. **** YOU WILL NOT BE CHARGED THE NON-MEMBER/FULL-DAY AMOUNT UNLESS APPLICABLE.****
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
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Type
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Caregiver
Father
Friend
Guardian
Mother
Nanny
Parent
Relative
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:
*
Emergency Contact Info (NOT Contact #1 or #2)
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities and/or Special Needs (Leave blank if NONE):
Allergies and/or Medications (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities and/or Special Needs (Leave blank if NONE):
Allergies and/or Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities and/or Special Needs (Leave blank if NONE):
Allergies and/or Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities and/or Special Needs (Leave blank if NONE):
Allergies and/or Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities and/or Special Needs (Leave blank if NONE):
Allergies and/or Medications (Leave blank if NONE):
Questions/Options:
I understand that C.I.T.Y. Club staff will manually deduct applicable discounts prior to my credit card being charged.
*
Yes
No
Please note here Full Day (9-4), Half Day AM (9-12:30) or Half Day PM (12:30-4). No note will assume a Full Day and charge accordingly.
*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
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
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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