radKIDS Burnet Series TWO June 29th

Child's Full Name

First NameLast Name

Child's Date of Birth

Date

Child's Age

Please make sure your child's age matches the age group selected above

Parent/Guardian Name

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email Address

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Have you taken radKIDS before?

Instructor?

How did you hear about us?

My Products

5-7yrs 10am - 11:30am (NEW STUDENT)

Must complete and pass Series One before registering for Series Two

$5 Quantity

5-7yrs 10am - 11:30am (RETURNING STUDENT)

MUST BE A HCCAC radKIDS SERIES TWO RETURNING STUDENT TO QUALIFY

$ Free Quantity

8-12yrs 12pm - 1:30pm (NEW STUDENT)

Must complete and pass Series One before registering for Series Two

$5 Quantity

8-12yrs 12pm - 1:30pm (RETURNING STUDENT)

MUST BE A HCCAC radKIDS SERIES TWO RETURNING STUDENT TO QUALIFY

$ Free Quantity

5-7yrs 4pm - 5:30am (NEW STUDENT)

Must complete and pass Series One before registering for Series Two

$5 Quantity

5-7yrs 4pm - 5:30pm (RETURNING STUDENT)

MUST BE A HCCAC radKIDS SERIES TWO RETURNING STUDENT TO QUALIFY

$ Free Quantity

8-12yrs 5:30pm - 7pm (NEW STUDENT)

Must complete and pass Series One before registering for Series Two

$5 Quantity

8-12yrs 5:30pm - 7pm (RETURNING STUDENT)

MUST BE A HCCAC radKIDS SERIES TWO RETURNING STUDENT TO QUALIFY

$ Free Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

radKIDS Burnet Series TWO

My Products*

My Products