Spring Camp Registration

Name of Parent or Guardian*

First Last

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Student Information

Please click on the "+" sign to register additional siblings on this form.

First Name	Last Name	Age	Shoe Size	Height	Food allergies/dietary restrictions	Injuries or medical conditions	Medications

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Number of students

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Would you like to get our email Newsletter? (Typically > 1 email month)

Sure!
Nope
I'm already subscribed

May we use photo/video of you for future promotions?

Yes
No

Would you like us to share your contact info with other parents or class participants for carpooling purposes?

Yes
No

Payment

Registration Fee Total

Price:

Have you received a scholarship?

Scholarship

If you've received a scholarship enter the code here.

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Pay Deposit or in Full?

Pay in Full
Pay Deposit

Remaining Balance Due

Price: $0.00

Remaining Balance Due

Price: $0.00

Total Due Today

$0.00

How would you like to pay?

PayPal
Credit Card
Check

Convenience Fee

Price:

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Spring Break Circus Camp Registration

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Payment