RODF Swim Party - July sign-up
Fill out the form carefully for sign up of each participant.
Wednesdays
7/1, 7/8, 7/15, 7/22 & 7/29 - 4:00 to 5:30 PM
Thursdays
7/2, 7/9, 7/16, 7/23, & 7/30- 4:00 to 5:30 PM
Class Participant Name
*
First Name
Last Name
Family/Parent/Guardian Name
*
First Name
Last Name
City where you live?
*
Age
*
Gender
*
Male
Female
N/A
Number in Household
*
Over 62
*
Mobile Number
*
-
Area Code
Phone Number
Ethnicity
*
Hispanic/Latin
African American
Asian
White Caucasian
E-mail
My Products
prev
next
( X )
July Monthly Family Donation
$100.00
$
100.00
July IRC Reimbursement
$100.00
$
100.00
Already donated this month / Self Determination
Free
$
Free
You must click PayPal to submit.
Total
$0.00
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit Signin
Should be Empty: