September 30th TLC Kids & Youth Early Out Registration Form

Wednesday, September 30th 2-5:15pm | Register your child(ren) for the early out event at the end of September! We are heading out for fall fun at Otter Berry Farm!

Registration Deadline: Wednesday, September 23rd

How many youth are your registering?

Please select one option.

1 2 3 4

Name of Parent

Name of Youth

Grade of Youth

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Name of Youth

Grade of Youth

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Name of Youth

Grade of Youth

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Name of Youth

Grade of Youth

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Email of Parent

This address will receive a confirmation email

Phone of Parent

Would a parent be willing to come with and help at this event?

Please select one option.

Yes No Maybe

If you have a high school student that would like to come help with the early out please write their name here - thanks!

Anything else we should know?

Payment

1 Kid - Pay by Debit/Credit Card ($10) 2 Kids - Pay by Debit/Credit Card ($20) 3 Kids - Pay by Debit/Credit Card ($30) 4 Kids - Pay by Debit/Credit Card ($40) Pay with cash or check the day of ($0) Use our YFM Account ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Wednesday, September 30th 2-5:15pm

Register your child(ren) for the early out event at the end of September! We are heading out for fall fun at Otter Berry Farm!

Registration Deadline: Wednesday, September 23rd

September 30th TLC Kids & Youth Early Out Registration Form

Description

Please Fix the Following