Online Registration SPNDS Camp

RESERVATION & REGISTRATION FORM

SPNDS Summer Camp 2019

* Indicates required field

Are you making a reservation for the SPNDS Summer Bridge Camp? *

Yes. Reservation for all 3 Weeks Yes. Reservation for week 1 (. Would like to attend as a Drop In.

Registering for "Fall Fun" Being with Baby Music & Massage: *

All 4 Weeks of Class - Child ($60) All 4 Weeks of Class - Twins ($90) Pay by Class-Drop In Rate ($18)

Name of Child 1 attending class. *

Date of Birth / Age *

Name of Child 2 attending class. *

Date of Birth / Age *

Mother Name or Legal Guardian *

First

Last

Father's Name or Legal Guardian *

First

Last

Contact Email *

Mother's Cell Number *

Work/ Other Number *

Father's Cell Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Caregiver's Cell Number if applicable. *

Emergency Contact *

Does your child have any allergies or special needs we should be aware of? Please be specific. *

Any other questions, concerns or comments? Thank you! *

Submit

Payment instructions will be sent by email to you after submitting the online registration form.