Monthly Membership Registration Form

Monthly Membership Registration Form

Enter parent and child details and agree to monthly automatic payments with a 30-day cancellation notice.
Parent Full Name

First NameLast Name
Parent Email Address
example@example.com
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Child Full Name

First NameLast Name
Child Date of Birth

MonthDayYear
Date
Child 2 Full Name

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Date
Child 3 Full Name

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Date
Membership Subscription and Payment Authorization
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Monthly Membership One Child
Automatic monthly membership for Lume indoor playspace access.

$40.00 for the first month then,$35.00 for each month



Monthly Membership Two Children
$65.00 for the first month then,$60.00 for each month



Monthly Membership Three Children
$85.00 for each month
By signing this I am agreeing to the above statements.
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