Saturday Program Payment Form 2-4 y.o. 2021-2022
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
prev
next
( X )
Saturday Morning Monthly (4 Days)
$
225.00
Saturday Morning 1/3 (12 school days)
$
680.00
Saturday Morning Semi-annual (18 school days)
$
988.00
Saturday Morning Annually (36 school days)
$
1,812.00
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Signature
Clear
Submit
Should be Empty: