11^th Annual Game Day Learn & Play

                                                    Pre-Registration Form

              Information:                                   Sign Up for (circle)           Member       Non-Member                                                                                               

Child's Name:____________________     September 2: Australia                         $32.00                      $34.00

Child's Age:______________________     September 9:  Night Watch                  $32.00                     $34.00

Parent's Name:___________________    September 23:  Weather                         $32.00                     $34.00

Address:_________________________   September 30:  Food for Thought        $32.00                    $34.00

             __________________________         

                                                                     October 14: Renaissance                     $ 32.00                    $34.00

Name/Ph.#:_______________________           

                                                                     November 14:  Junior Sherlock             $32.00                   $34.00

Age Groups                                                 All 6 sessions:                          $180.00                   $192.00

(please circle one)                                                           

                                                                                                                   Subtotal:__________

4 - 5         6 - 7         8 - 9         10 - 12                                                                      Discount:_________

                                                                                                                   Total:____________

Emergency Contact (other than parents):                                                     

 Name:_______________________________                                                      

 Phone#:______________________________                                              

 Relationship:__________________________           

Method of Payment: (please circle one)   

  Visa / MasterCard            Check            Cash                                            

                                                                                                                                                                                                                     Name:_____________________________                                                            

Credit Card#:________________________ 

Exp. Date:___________________________