*Note: if a class doesn’t meet minimums, they will be canceled and you will be refunded the full amount. 2022 Christmas Break Mini Camp Parent/Guardian Contact Info Name * First Last * Last Relation to Child * Email * Phone * Home Address Home Address Home Address Home Address City City State/Province State/Province Zip/Postal Zip/Postal Student Info Name * Name First First Last Last Birthdate * Please list any allergies the student has. Days to Attend Tuesday 12/20/2022 Wednesday 12/21/2022 Thursday 12/22/2022 Add Remove Total $ Credit Card * Credit Card Credit Card Number Credit Card Number Expiration Month Month 1 2 3 4 5 6 7 8 9 10 11 12 Expiration Month Expiration Year Year 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year CVC CVC If you are human, leave this field blank. Submit