EmailMe Form - Youth Winter Program

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Parent Guirdian Name *
First Last
Phone *
### - ### - ####
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Emergency Contact (If other than above parent)

Full Name

Relationship to child

Phone

Address
First Child *

Full Name

Male or Female

Date of Birth

Health problems or any medical attention
Second Child (Optional)

Full Name

Male or Female

Date of Birth

Health problems or any medical attention
Third Child (Optional)

Full Name

Male or Female

Date of Birth

Health problems or any medical attention
Payment: You will be directed to payment page once you submit

Check your payment amount:
$150 (one youth)
$250 (two sibling discount rate)
$300 (three sibling discount rate)
For financial aid please fill out the following. You will get an email confirmation if the following amount was approved before the registration deadline.

How many youth/sibling are you registering?

What is the total amount you can afford?

Full Name
Male or Female
Date of Birth
Health problems or any medical attention

How many youth/sibling are you registering?
What is the total amount you can afford?