EmailMeForm
Jax FL - Sk8 City - Weekly Quick Pay 2023
Week Selection
*
Please select
Week1 - Mon July 10 - Fri July 14
Week 2- Mon July 17 - Fri July 21
Week 3 - Mon July 24- Fri July 28
Week 4 - Mon July 31 - Fri Aug 4
Week 5 - Mon Aug 7 - Fri Aug 11
Week 6 - Mon Aug 14 - Fri Aug 18
How Many Children are Attending?
*
Please select
1 Child
2 Children
3 Children
Child #1 Name
First
Last
Child #1: Registration Status
Please select
First Time - Need to Pay Reg Fee ($50)
Already Paid Reg Fee ($0)
1 Child: Camp Week Duration
Please select
1 Child: Full Day (7:30am-6:00pm)
1 Child: Morning Half Day (7:30am-12:30pm)
1 Child: Afternoon Half Day (1:00pm-6:00pm)
1 Child: Only 1 Day in the Week
1 Child: 2 Days
1 Child: 3 Days
Child #2 Name
First
Last
Child #2: Registration Status
Please select
First Time - Need to Pay Reg Fee ($100)
Already Paid Reg Fee ($0)
2 Children: Camp Week Duration
Please select
2 Children: Full Day (7:30am-6:00pm)
2 Children: Morning Half Day (7:30am-12:30pm)
2 Children: Afternoon Half Day (1:00pm-6:00pm)
2 Children: Only 1 Day in the Week
2 Children: 2 Days
2 Children: 3 Days
Child #3 Name
First
Last
Child #3: Registration Status
Please select
First Time - Need to Pay Reg Fee ($100)
Already Paid Reg Fee ($0)
3 Children: Camp Week Duration
Please select
3 Children: Full Day (7:30am-6:00pm)
3 Children: Morning Half Day (7:30am-12:30pm)
3 Children: Afternoon Half Day (1:00pm-6:00pm)
3 Children: Only 1 Day in the Week
3 Children: 2 Days
3 Children: 3 Days
What Day (s) will you be attending?
Monday
Tuesday
Wednesday
Thursday
Friday
Mothers or Fathers Name
*
First
Last
Cell Number
*
###
-
###
-
####
Email
need for payment confirmation
Do you Need ALM as an Primary Insurance for the Week
*
Yes - I want ALM Insurance as Primary ($10 family)
No - Ill use my Own Insurance as Primary ($0)
Do you Need an additional ALM Shirt?
*
Yes - I want an additional ALM Shirt($10)
No - I do not need an additional ALM Shirt ($0)
Total
$2.25
