Registration
Drop off: 6pm & Pick up: 10pm $23 per child ages 5-12 by August 22 July 22nd price goes up to $28
Event:
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 Info
(Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Is the participant a male or female?*
Does the participant have any special Needs? If so, please explain*
Does the participant have any allergies? If so, please explain*
Do you have any questions or concerns about this event? If so, please explain.
 
Additional Information:
 
 
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:*