Saturday Program Payment Form 2-4 y.o. 2022-2023
Minimum 4 kids are required to form a class.
Student Name
First Name
Middle Name
Last Name
Birthday
In Good Health?
Yes
No
Parent Name
First Name
Middle Name
Last Name
E-mail
*
Authorization for Medical Treatment: in the event that parents/guardians named on this form cannot be reached, I authorize officials of the Blue Giraffe Education Center to consent on my behalf, to provide emergency treatment for my child
*
I agree
I understand that there are no refunds or replacements for missed classes
*
I agree
My Products
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Saturday Morning Monthly (4 Days)
$
300.00
Second Child 20% off
$
240.00
Saturday Morning Semi-annual (18 school days)
$
1,275.00
Second Child 20% off
$
1,020.00
Saturday Morning Annually (36 school days)
$
2,400.00
Second Child 20% off
$
1,920.00
Total
$
0.00
Credit Card
Signature
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Submit
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