Event Reservation Form

Parent Information

Title

First Name

Last Name

Address

City

State

Zip

Phone

Tuition Details

Please choose from the following options

Tuition Option	Qty	Amount
Registration $100		100.00
Security Guard $250		250.00
Full 6 weeks full day paid in full $2500		2500.00
Full 6 weeks 1/2 day paid in full $2000		2000.00
Full 6 weeks full day first payment of 3 $834		834.00
Full 6 weeks 1/2 day first payment of 3 $667		667.00
Weekly rate full day $450		450.00
Weekly rate 1/2 day $400		400.00
Camp T-shirt $20		20.00
Lunch full summer $250		250.00
Lunch weekly rate $42		42.00
Total

Child Name

Payment Information

Please enter your credit card info. This amount will be charged upon submitting the form.

Total Amount

Card Number

Card Expiration

Security Code

Same as above

Name on Card

Billing Address

Zip Code