Registration

FEES WILL BE POSTED AFTER QUANTITIES HAVE BEEN REVIEWED! $20/shirt Lily, a 2-year old resilient, happy, and Tumble-Bee loving Rockland County girl, is courageously battling (DIPG), a rare and aggressive pediatric brain cancer. Lily attends classes at Tumble-Bee, and her family is a part of the Tumble-Bee family. We are coming together to support our family member in this difficult time. Although Lily has been given 6-9 months to live, in the midst of this painful reality, she continues to defy expectations with her laughter and resilience that shine brighter than her dark prognosis. The financial burden of medical treatments, experimental therapies, and, unfortunately, end of life care is overwhelming for Lily's family. Thank you for opening your hearts to Lily's story! Please complete this form to order an event t-shirt! T-shirts will be available for pickup at Tumble-Bee at the event. (Please put N/A for Emergency Contact)
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:
Number of Youth Extra Small T-shirts
Number of Youth Small T-shirts
Number of Youth Medium T-shirts
Number of Youth Large T-shirts
Number of Adult Small T-shirts
Number of Adult Medium T-shirts
Number of Adult Large T-shirts
Number of Adult XL T-shirts
 
Additional Information:
 
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Enter your Full Name: *   
 
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:*
 
 
eCheck/Bank Draft:
Bank Name:
Bank Routing Number: (9-digit number)
Your Account Name: (Your name on your bank statement)
Your Account Type:   Account Number: