Multiple Children in Brigade?

Please only register one child at a time using this registration form.

Paper registration available.

Register for our last session of the program year.

Quantity
Price
Total
Session 3

SESSION #3 - $60 Dates: March 5 and 19, April 2 and 16 (1-3pm)

X
$
60.00=
$
0

Student Contact Information

Country*
Email*
Confirm Email*
Phone*
Birthdate

Parent/Guardian Information

Parent/Guardian Information: This is used as emergency contact information and to better understand the families we serve. Please list information that is different than that which is listed in the Child information area above.

Parent/Guardian 1 Address
Parent/Guardian 1 Cell Phone
Parent/Guardian 1 Email
Parent/Guardian 1 Employer
Parent/Guardian 1 Home Phone
Parent/Guardian 1 Name
Parent/Guardian 1 Relationship to Brigade Member
Parent/Guardian 2 Address
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Email
Parent/Guardian 2 Employer
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Name
Parent/Guardian 2 Relationship to Brigade Member

Payment Information

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
Additional Comments
Powered by eTapestry