Rumble in the Jungle 2012 Registration Form
Please submit one form per child enrolled. Thanks.
Student's Name DOB Age
Will you be paying in full for the summer?
Will you be paying in 2 monthly installments? Automatic debit is required with this option.
E-signature
E-mail
Referred by
CREDIT CARD AUTHORIZATION
Name on Card
Type of Card
Card Number
Expiration Date
By submitting this form, I agree to have Wild About Learning charge my credit card for the following charges:
Paypal payments are also accepted via their website at www.paypal.com. Our email code to send payment via Paypal is wildaboutlearning@verizon.net. Once you submit this form, go to our Payment Center link at the top of our website.
Class confirmation will not be made until all fees are paid.
