1. Child/ren’s Information Child 1* First Name Middle Name Last Name Child 2 First Name Middle Name Last Name Child 3 First Name Middle Name Last Name E-mail* Full Day - Number of Children Enrolling 1 Child2 Children3 Children Haf Day - Number of Children Enrolling 1 Child2 Children3 Children Total $0.00 Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration Year Agreement* I am signing up my child for Chai Tots Winter Camp January 27-31 2025. The tuition is non refundable & non transferable. Should be Empty: Submit This page uses TLS encryption to keep your data secure.