Registration
2019 Winter Camp 1/2 Day Registration
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Relationship to Student*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Please provide the name and phone number of an Emergency Contact if we are unable to reach you
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Please supply an emergency contact name and number for us to reach you during Winter Camp.*
Please list any Allergies or Medical Conditions that your child has .*
Registration requires a deposit of $75.00/child (balance due by Feb 10). Supply credit card details below. Select YES to charge your card the full balance, select NO to charge deposit only.*
If you have a COUPON CODE, please enter it here.
 
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:*