Drop off: 6pm & Pick up: 10pm Early Bird Registration =$23 per child ages 5-12 Regular Price= $28
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
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: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*