Spring Camp Registration | The Rumpus Room

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

Number of students

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

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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: $260.00

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

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Total Due Today

$0.00

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Convenience Fee

Price: $2.00

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Card Number Expiration Date Security Code Cardholder Name