Child #1 *

First Name

Last Name

Child #1 Date of Birth (Note: Child should be in the range of 3 to 6 years old unless approved otherwise) *

MM

DD

YYYY

Child #2

Enter Family Discount Code E5EXNV8 at checkout

First Name

Last Name

Child # 2 Date of Birth

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Primary Phone *

(###)

###

####

Accompanying Adult *

First Name

Last Name

Emergency Contact *

In the event that the child, parent, guardian or accompanying adult needs assistance.

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Payment Plan *

Reigstration is not confirmed until a deposit or full payment has been received or a payment plan has been set up.

I will pay the deposit of $25 now to secure my child's registration

I will make full payment now to secure my child's registration

I will contact the office to set up a payment plan