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 - July 25th 12:30 - 2:30pm
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 62
*
Mobile Number
*
-
Area Code
Phone Number
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
E-mail
*
My Products
prev
next
( X )
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)
Total
$0.00
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit Signin
Should be Empty: