Power Programs Registration

Session*

Program*

PowerKidz Day*

Participant Name*

First NameMiddle NameLast Name

Participant Birth Date*

Date

Parent or Guardian Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Medical History / Allergies / Special Instructions

Session Options*

PowerKidz Full Session (10 weeks)

Full 10 Week Program

$135.00

PowerKidz Single Session (First session)

Single session for those that want to pay as you go

$15.00

PowerSproutz /Totz Full Session (10 weeks)

Full 10 Week Program

$90.00

PowerSproutz /Totz Single Session (First Session)

Single Session for those that want to pay as you go

$10.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Afterpay

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PowerProgram Registration