1. Child/ren’s InformationChild 1*First NameMiddle NameLast NameChild 2First NameMiddle NameLast NameChild 3First NameMiddle NameLast NameE-mail*Number of children enrolling*1 Child2 Children3 ChildrenTotal$0.00PaymentCredit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearAgreement*I am signing up my child for Chai Tots Winter Camp January 24-28 2022. The tuition is non refundable & non transferable.Should be Empty: Submit This page uses TLS encryption to keep your data secure.