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Program Registration
Program Registration
1
Participant
2
Programs
3
Payment
From Registration
Thank you for your registration, please complete your
Program Registration
below.
Participant's Info
Participant's Name
*
First
Last
Birth Date
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
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2022
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1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Age
*
Participant requires
*
Trained adult aide – There will be an additional cost for the aide per program
Teen volunteer
I will supply my own aide – no additional cost
Parents Name
*
First
Last
Parent Email
*
Parent Cell
*
Programs
Fall Fun
10:00 am to 12:00 pm
Price:
$5 per date
Register for Fall Fun
September 12
September 19
October 3
October 11
October 31
November 21
Fall Fun
Price:
Fall Fun - Quantity
Art and Cooking #1 Fall Session
Wednesdays
, 4:30pm-6:30pm
Price:
$300
Deposit:
$50 (non-refundable); applied to total cost
Aide Fee:
$400
October 6
October 13
October 20
October 27
November 3
November 10
November 17
December 8
December 15
December 22
Register for Art and Cooking #1 Fall Session
Register for Art and Cooking #1 Fall Session
Art and Cooking #1 Fall Session
Price:
Art and Cooking #1 Fall Session Aide Fee
Price:
Art #2 Fall Session
Wednesdays
, 5:00pm-6:00pm
Price:
$150
Deposit:
$50 (non-refundable); applied to total cost
Aide Fee:
$200
October 6
October 13
October 20
October 27
November 3
November 10
November 17
December 8
December 15
December 22
Register for Art #2 Fall Session
Register for Art #2 Fall Session
Art #2 Fall Session
Price:
Art #2 Fall Session Aide Fee
Price:
Sports and Vocational Skills #1 Fall Session
Mondays
, 4:30pm-6:30pm
Price:
$330
Deposit:
$50 (non-refundable); applied to total cost
Aide Fee:
$440
October 11
October 18
October 25
November 1
November 8
November 15
November 22
December 6
December 13
December 20
Register for Sports and Vocational Skills #1 Fall Session
Register for Sports and Vocational Skills #1 Fall Session
Sports and Vocational Skills #1 Fall Session
Price:
Sports and Vocational Skills #1 Fall Session Aide Fee
Price:
Sports #2 Fall Session
Mondays
, 5:00pm-6:00pm
Price:
$165
Deposit:
$50 (non-refundable); applied to total cost
Aide Fee:
$220
October 11
October 18
October 25
November 1
November 8
November 15
November 22
December 6
December 13
December 20
Register for Sports #2 Fall Session
Register for Sports #2 Fall Session
Sports #2 Fall Session
Price:
Sports #2 Fall Session Aide Fee
Price:
Form Calculations
Deposit Amount
Total
Deposit
Total
Total
$0.00
Total
Program Summary
Payment
{:68}
Deposit
$0.00
Balance
$0.00
Total
$0.00
Total
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Expiration Date
Security Code
Cardholder Name
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