Apple Valley Location
22092 HWY 18, Apple Valley, Ca
Saturday Camp
Fill out the form carefully for sign up of each participant. Lunch: Pizza
Class Date
VICTORVILLE LOCATION Saturday - September 5th 10:30am - 12:30pm
Class Date
APPLE VALLEY LOCATION Saturday - September 26th 10am - 1pm
Class Participant Name
*
First Name
Last Name
Family/Parent/Guardian Name
*
First Name
Last Name
City
*
Age
*
Gender
*
Male
Female
N/A
Number in Household
*
Number over 62
*
Mobile #
*
-
Area Code
Phone Number
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
E-mail
*
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September Monthly Family Donation
$100.00
$
100.00
September IRC Reimbursement
$100.00
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
Free
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Total
$0.00
$
0.00
Payment Methods
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