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Membership Fee

You can pay for membership costs but please select the box "pay 3% fee" at the bottom to cover the fee cost.

If you prefer not to pay the fee, please send a check prior to the membership due date.

Are you a member/Client

*

Yes

No

Are you a parent or caregiver

*

Parent

Caregiver

Name

First Name

Last Name

Mobile Phone

*

Email

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Member Name

*

First Name

Last Name

Member Mobile Phone

*

Member email

*

Verify Email

*

Member Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Fee Amount and Description

*

$1 - 1 Day a Week

$1 - 1 Day a Week

$1 - 1 Day a Week

$1 - 1 Day a Week

$1 - 1 Day a Week

$30 - Evening Program for Month

$

Donation Schedule

Add 3% to my total amount to help cover the payment processing fees