New Location
15329 Bonanza Road, Suite C, Victorville, CA 92392
Saturday Camp
Fill out the form carefully for sign up of each participant. Lunch: Pizza
Class Date
Saturday - May 2nd 10:30am - 12:30pm
Class Date
Saturday - May 23rd 12:30pm - 2:30pm
Class Participant Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Age
*
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
Number in Household
*
Number over 62
*
My Products
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May Monthly Family Donation
$100.00
$
100.00
May Monthly Family Donation
May IRC Reimbursement
$100.00
$
100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles
Already donated this month / Self Determination
Free
$
Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Total
$0.00
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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