Registration
When: December 11th, 2021 Time: 6:00 pm - 10:00 pm Activities: Bounce house, Games, & Fun Food: Pizza & Juice Register by end of day 12/10: $25 Ages 3+, must be able to use the bathroom independently
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? (If enrolling more than 1 child, please indicate either cheese or pepperoni for each child in the "additional information" box below)
Pepperoni Pizza? (If enrolling more than 1 child, please indicate either cheese or pepperoni for each child in the "additional information" box below) (checked=yes)
 
Additional Information:
 
 
Other Questions/Comments: