RODF Swim Party - June signup
Fill out the form carefully for sign up of each participant.
Week 7/1, 7/3, 7/4 no class - 4:00 to 5:30 PM
Monday - Wednesday - Thursday
Week 7/8, 7/10, 7/11 - 4:00 to 5:30 PM
Monday - Wednesday - Thursday
Week 7/15, 7/17, & 7/18 - 4:00 to 5:30 PM
Monday - Wednesday - Thursday
Week 7/22, 7/24, 7/25 - 4:00 to 5:30 PM
Monday - Wednesday - Thursday
Week 7/29, 7/31 last day - 4:00 to 5:30 PM
Monday - Wednesday - Thursday
Class Participant Name
*
First Name
Last Name
Family/Parent/Guardian Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Age
*
Number in Household
*
Over 62
*
City where you live?
*
Ethnicity
*
Hispanic/Latin
African American
Asian
White Caucasian
E-mail
Mobile Number
*
-
Area Code
Phone Number
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July Monthly Family Donation
$
50.00
July Monthly Family Donation
$
75.00
July Monthly Family Donation
$
100.00
Already donated this month.
$
Free
You must click PayPal to submit.
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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