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* Number of children enrolling* 1 Child 2 Children 3 Children Total $0.00 Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Agreement* I am signing up my child for Chai Tots Winter Camp January 23-27 2023. The tuition is non refundable & non transferable. Should be Empty: Submit This page uses TLS encryption to keep your data secure.