15329 Bonanza Rd.
Victorville, Ca 92392
Choir Class
Fill out the form carefully and sign up of each participant.
Class Date
*
October 7th, 14th, 21st, and 28th - Tuesdays, 5-6pm
Class Participant Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Number in home over 62yrs
*
Age
*
Number in Household
*
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
City where you live
*
Family/Parent/Guardian Name
*
First Name
Last Name
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
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October Monthly Family Donation
$
100.00
October Monthly Family Donation
October IRC Reimbursement
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisbilities@gmail.com)
Total
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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