What's your first name? *

 
Hey {{answer_19436175}}, nice to meet you.

What is your last name?

 
And your phone number? *

 
Great! Now that I have all your basic information, we're ready to proceed with registration.

 
Which location are you registering at? *


 
What are your children's names? *

please use "and" to separate names.
 
What's {{answer_19638240}}'s age(s)?

 
Finally, we'll need some medical information.

This information will only be released managers and to medical professionals in the event of an emergency.
 
Will you be leaving an Epi-Pen for your child with us? *

It can treat severe asthma attacks and allergic reactions (including anaphylaxis) in an emergency situation.
     
 
Will you be leaving a rescue inhaler with us or with your child? *

Inhalers are devices that contain medicines used to treat asthma.

 
Finally, what's a good emergency contact for {{answer_19638240}}? *

Just a first and last name to start with.
 
And {{answer_19643394}}'s phone number? *

We'll be using this number in case of an emergency and your primary contact is unavailable.
 
Your total to register for 20 hours of Young Art spring break camp time will be. *

 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


 
What day's and times are you planning on stopping by? *

We know schedules change so don't worry if something comes up just let us know and we can reschedule.
Thanks for registering {{answer_19638240}}, we look forward to having them at our camp.
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