KOB Registration Form

KOB Registration Form

Information of Child
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Second Child
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Address*

Street Address

CityState / Province

Postal / Zip Code
Information of Parent
Mother/Guardian*

First NameLast Name
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.

Registration

Registration Fee

$35.00 Quantity

2nd family member

$35

$70.00 Quantity

3rd family member

$30.

$100.00 Quantity

4th family member

$25

$125.00 Quantity

5th family member

$20

$145.00 Quantity

6th family member

$15

$160.00 Quantity

7th family member

$10

$170.00 Quantity

Monty Python

Comedy Classes

$225.00 Quantity

Enter coupon

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Photo Waiver Release Form
I hereby grant the releasee permission to use photographs in any of the following:

Release of Photographs in Web-based publications

Print Advertisements

Organization Bulletin

Social Media
Signature*

Should be Empty: