Tiny Trailblazers Registration
Please complete this form. If you are not a member, please also complete the waiver and media release on the next page.
Caregiver Name
*
First Name
Middle Name
Last Name
Child #1 Name
*
First Name
Middle Name
Last Name
Child age
*
18 months-5 years old
Child #2 Name
First Name
Middle Name
Last Name
Child age
18 months-5 years old
Caregiver E-mail (@arizona emails are not accepted)
*
Phone Number
*
-
Area Code
Phone Number
Please enter your insurance provider information:
Insurance Information is required.
Who is your Insurance Provider?
*
Required Field
What is your Policy Number?
*
Required Field
Back
Next
Anything you wish to share about your child(ren)?
*TRAK welcomes children of all abilities.
If you are NOT a current TRAK member, please also read and then sign the following waiver, required for all programs and tours of our property.
Names of all participants covered by this waiver:
*
This includes caregiver and child(ren).
Parental/Legal Guardian Name, Printed
*
Parent/Legal Guardian Signature
*
Date:
*
Media Release
I hereby grant or deny permission for photographs or video recording of myself or child(ren) to be used for promotional purposes:
Media Permission
*
Granted
Denied
Parent/Legal Guardian Signature:
*
Are you a TRAK Member?
My Products
prev
next
( X )
Tiny T's Member Payment for One Child
$98.15
$
98.15
Tiny T's NonMember Payment for One Child
$123.89
$
123.89
Tiny T's Member Payment for Two Children
$195.98
$
195.98
Tiny T's NonMember Payment for Two Children
$247.48
$
247.48
Tiny T's MILITAY Member Payment
$88.63
$
88.63
Tiny T's MILITARY Non-Member Payment
$116.17
$
116.17
Total
$0.00
$
0.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Register Class
Should be Empty: