Let's E.A.T Registration

Let's E.A.T Registration

Grades 5th - 8th @Southside Recreation Center

Child's Name*

First NameLast Name
Date Of Birth*

MonthDayYear
Current School*
5th6th7th8thOther

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number*
Mother's Name

First NameLast Name
Father's Name

First NameLast Name
E-mail*
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Parent / Guardian Signature*
Date Signed*

MonthDayYear
Registration Fee*
prevnext( X )
Session - Oct. 2$30.00

Session - Oct. 7$30.00

Session - Oct. 9$30.00

Session - Oct. 14$30.00

Session - Oct. 16$30.00

Session - Oct. 21$30.00

Session - Oct. 23$30.00

Session - Oct. 28$30.00

Session - Oct. 30$30.00

All Sessions$200.00

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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