June or August Session (required)

Child's Name (required)

Child's Date of Birth (required)

Parent's Name (required)

Parent's Email (required)

Emergency Contact 1: (required)

Emergency Contact 2: (required)

Does your child have any medical conditions that we should know about? (required)

If yes, please explain

Is your child taking any type of medication? (required)

If yes, please explain

I grant permission for my sons picture to be used for marketing purposes by WBC.(required)

Parent/Guardian Signature

We take your privacy SERIOUSLY and will take all measures to protect your personal information. What information do we collect? We only collect information that we need that is related to your order. This includes your: Billing Address, Email Address, Credit Card Information. In addition we also collect information on your IP address, browser type, and Refer URL data. We use this data to prevent hacking attempts, help us know what web browsers people are using, and find out where our visitors are coming from so that we can improve our marketing. How Is My Information Used? Your information is only used to fill your order. We do not sell or redistribute your information to ANYONE.
Payment is non-refundable.