Classes
schedule
descriptions
Programs
Personal Training
Performance Training
Fitness
Massage
Seniors
adult art
Events
Sports
Kids
KidSpace
Parties
COVIDWAIVER
Kid's Night Out: May 22, 2020
HOUSE CHARGE REGISTRATION FORM
If current PEAC Members would like to register their child for KNO and use the account PEAC has on file for payment please fill out this form.
*
Indicates required field
PEAC Member Name
*
First
Last
Phone
*
Email
*
CHILD 1 Name & Date of Birth
*
CHILD 2 NAME & Date of Birth
*
CHILD 3 Name & Date of Birth
*
Child 4 Name & Date of Birth
*
Emergency Contact Name
*
In case parent cannot be reached.
EMERGENCY CONTACT NUMBER
*
Total Cost
*
$15 for first child, $10 each additional child.
By submitting this form I authorize PEAC to charge the TOTAL COST to the account I have on file.
Submit
Classes
schedule
descriptions
Programs
Personal Training
Performance Training
Fitness
Massage
Seniors
adult art
Events
Sports
Kids
KidSpace
Parties
COVIDWAIVER