PowerProgram Registration
Session
*
Please Select
2026 Session 4 : Oct - Dec
Program
*
Please Select
PowerKidz I (ages 7-9) Tue 5:00 - 5:45
PowerKidz II (ages 10-12) Tue 6:00 - 7:00
PowerKidz Day
*
Please Select
Wednesday
Thursday
Participant Name
*
First Name
Middle Name
Last Name
Participant Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent or Guardian Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical History / Allergies / Special Instructions
Session Options
*
prev
next
( X )
PowerKidz Single Session (First session)
Single session for those that want to pay as you go
$15.00
$
15.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Please verify that you are human
*
Submit
Should be Empty: