Get Air Ongoing Every 1st Saturday and 4th Saturday
Fill out the form carefully and sign up of each participant.
Class Date
July 25th - from 10AM-12PM
Jumpers Birthday
*
-
Month
-
Day
Year
Date
Class Participant Name
*
First Name
Last Name
Family/Parent/Guardian Name
*
First Name
Last Name
City where you live
*
Age
*
Gender
*
Male
Female
N/A
Number in Household
*
Number over age 62
*
Mobile Number
*
-
Area Code
Phone Number
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
E-mail
*
My Products
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2 Hour Jump Session 10.00 Per Person
$11.00
$
11.00
July Jump Cost per visit without a pass. 1.00 Fee for PayPal
July Monthly Family Donation
$100.00
$
100.00
July Monthly Family Donation
July 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)
Purchased Annual Pass to Get Air
Free
$
Free
Purchased Annual Pass to Get Air
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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