Enrichment Registration

Waverley Belmont - LEGO CLUB Session #1 - 3:00pm-4:30pm

September 6, 13, 20, 27, October 4, 18

Price:
$165.00

Waverley Belmont - LEGO CLUB Session #2 - 3:00pm-4:30pm

October 25, November 1, 15, 22, 29, December 6

Price:
$165.00

Waverly Belmont - LEGO CLUB Session #3 - 3:00pm-4:30pm

Jan 24, 31 February 7, 14, 21, 28

Price:
$165.00

Waverly Belmont - LEGO CLUB Session #4 - 3:00pm-4:30pm

March 7, 21, 28, April 4, 11, 18

Price:
$165.00

JULIA GREEN ELEMENTARY

TUESDAYS - Grades: K-4th

Cost: $165.00/per 6 week session

Julia Green - LEGO CLUB Session #3 - 3:00pm-4:30pm

Jan 24, 31 February 7, 14, 21, 28

Price:
$165.00

Julia Green - LEGO CLUB Session #4 - 3:00pm-4:30pm

March 7, 21, 28, April 4, 11, 18

Price:
$165.00

Participant Information

BUILDER #1

First Name*

Last Name*

School*

Grade*

Sex*

Birthdate*

Additional Builder?

Additional Builder

BUILDER #2

First Name

Last Name

School

Grade

Sex

Birthdate

Household/Adult Primary Contact

Relationship*

Mother

Father

Other

Other Relationship

First Name*

Last Name*

Address*

Street Address

City

State

ZIP Code

Phone Number*

Alternate Phone

Email*

Emergency Contact Name*

Emergency Contact Phone*

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I give my permission for Camp Brick to use my child's picture for marketing purposes?*

Payment Information

SESSIONS FILL QUICKLY... PAY NOW TO RESERVE YOUR SPOT!

REGISTRATION IS ON A FIRST COME FIRST SERVE BASIS ONCE PAYMENT IS RECEIVED

REGISTRATION TOTAL

Payment Method*

Check/Money Order

Credit Card

Camp Brick Gift Card

A $7 Processing Fee has been added to your order

Price:

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

Month

Year

Security Code

Cardholder Name

Please make your checks payable to Camp Brick and mail to:

Jennifer Thayer

1105C North 8th Street

Nashville, TN 37207

If using a Camp Brick Gift Card please mail payment by check and include the card.

Please send payments to:

Jennifer Thayer

1105C North 8th Street

Nashville, TN 37207

* ALL FIELDS REQUIRED

Name

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