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2024 Kidtastic Blast Registration Form
The Cardio Club & Delhi Dance Studio is happy to have you!
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* Indicates required question
STUDENT NAME
*
Your answer
Birthdate, Age, Grade
*
Your answer
Any Known Allergies? (If yes, please explain?)
*
Your answer
Parent/Guardian
*
Your answer
Facebook Name (Communications will be through Facebook)
*
Your answer
Please select the weeks your child/children will attend
*
July 15-19 (Ages 5-9)
July 22-28 (Ages 5-9)
July 29-August 2 (Ages 5-9)
August 5-9 (Ages 7-10)
Required
Address
*
Your answer
Cell Phone
*
Your answer
Home Phone
Your answer
Email
*
Your answer
Emergency Contacts (Name & Number)
*
Your answer
Autopay info: Checking account number and routing number
Your answer
Autopay Info: Credit Card number, 3-digit code, expiration date and billing zip code
Your answer
Are you comfortable with your child walking to the library, as long as proper precautions are taken?
*
Yes
No
Do you need assistance to cover the cost for camp? If so, scholarships may be available.
Yes, I need a scholarship
No thank you
Clear selection
How did you hear about us?
Your answer
Digital Signature & Date
*
Your answer
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