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Session 2 Level 1, 11:15-12:00: June 30th-July 10th
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Signature Childs Name
Session 2: June 30th-July 10th: 11:15-12:00; Level 1
*
Check here
Please verify and acknowledge: June 30th-July 10th, 11:15-12:00, Level 1 for your child. Form must be completed with payment processed or slot will not be reserved
Childs Name
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First
Last
Age
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Parents Name
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First
Last
Phone
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Email
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Acknowledgement
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There is ABSOLUTELY NO REFUNDS. Please check this box to acknowledge
Registration Fee
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Price:
$45.00
Payment
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PayPal Checkout
Credit Card
Card Number
Expiration Date
Security Code
Card Holder Name
Waiver
*
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WAIVER FOR PARTICIPATION: In consideration of your accepting my child’s registration, I hereby for my child, my heirs, executors and administrator, waive and release any and all rights and claims for damages I or my child may have against the City of East Helena and it’s employees, representatives and successors for any and all injuries suffered by my child at the activities for which i am registering my child. Please check this box to acknowledge, and then sign and date below
Signature
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Clear Signature
Date
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