Saturday Program Payment Form 2-4 y.o. 2025-2026
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
$
300.00
Second Child 20% off
$240.00
$
240.00
Saturday Morning Semi-annual (18 school days)
$1,275.00
$
1,275.00
Second Child 20% off
$1,020.00
$
1,020.00
Saturday Morning Annually (36 school days)
$2,400.00
$
2,400.00
Second Child 20% off
$1,920.00
$
1,920.00
Third Child 50% off
$1,200.00
$
1,200.00
2 days
$150.00
$
150.00
Total
$0.00
$
0.00
Credit Card
Signature
Submit
Should be Empty: