Registration
When: February 13th, 2021 Time: 6:00 pm- 10:00 pm Activities: Bounce House, Valentine Crafts & Fun Food: Pizza Pre-register by end of day 2/12: $25 2/13 (day of): $30 Payment is required at time of sign-up Ages 3+, must be able to use the bathroom independently Spots available: 25 Please call the office if there is any question as to the number of spots available.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Cheese Pizza?*
Pepperoni Pizza?*
 
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:*