Adrenaline Rush Name: Age: DOB (mm/dd/yy): Address: Street Address City State / Province / Region Postal / Zip Code Parent(s) / Legal Guardian Name: Home Phone: Area Code - Phone Number Cell Phone: Area Code - Phone Number Parents E-mail: Emergency Contact: Emergency Contact Phone: Area Code - Phone Number Class Option:Unlimited Monthly ($99)Unlimited Monthly w/3 Mo. Commitment ($79)5 Class Pack (expires after 1 month) ($60)Drop In Rate ($15)SubmitResetAfter completing this form, you will be redirected Paypal to complete your payment. Then you will be redirected again to our Release of Liability Form. Please print and sign, and bring in with your child on the first day of camp. Thank you!