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Patch the Pirate Club (1st-6th grades)
Wednesday @ 7:00 PM (May 29-August 28)
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* Indicates required question
Child's Name
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Age
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Birth date
MM
/
DD
/
YYYY
Grade (just completed)
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Gender
Male
Female
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Street Address
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City, State, Zip
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Parents' Names
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Cell Phone (or best way to reach you)
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Email Address
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Club Shirt (please indicate one)
*
Purchase for $12
Rent for $2
Club Shirt Size
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Small
Medium
Large
Extra Large
Club Fee
*
$10
How many years has your child been in Patch Club?
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