Individual Registration

Please enter information in the form below to process registration for event AM Care 2023-2024.

How Many	Available places	How Many Kids
How Many Children Attending?	Unlimited

Participant's First Name *

Participant's Last Name *

Student's Grade *

Teacher Name *

Health Concerns / Diet / Allergies *

Please allow my child to ride home with

Emergency Contact Number *

Mother's Phone *

Main Contact Email *

Address *

City *

Zip *

Parents' First & Last Names *

Coupon

Amount

Discount Amount

Gross amount

Payment Method

Paypal
PayPal account not required. Credit/Debit cards accepted using PayPal.

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

By registering for this event, I have read and accept Waiver