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Individual Registration
Please enter information in the form below to process registration for event
Red Sock Hop
.
Participant's First Name
*
Participant's Last Name
*
Teacher Name
*
Student's Grade
*
--Select--
K
1st
2nd
3rd
4th
Health Concerns / Diet / Allergies
*
Please allow my child to ride home with
Emergency Contact Number
*
Mother's Phone
*
Main Contact Email
*
Address
*
City
*
Zip
*
Payment Information
Parents' First & Last Names
*
Amount
$
Payment Method
Payment to be made through School Payment Portal
Credit Card Number
*
Expiration Date
*
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Card (CVV) Code
*
Card Holder Name
*