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3rd & 4th Grade Club Chaverim Rockin' Jump

This Sunday, November 4th, we will be going to Rockin’ Jump to use their trampoline park for 1 hour. The Cost will be $20. The Cost will be $22.69 if you don’t already have the Rockin’ Jump socks.

The Event is for this Sunday November 4^th, 2018 starting at 12:45 in the conference room. The pick up time will be 2:30 PM At Rockin’Jump.

A waiver* must be filled out by the parent or legal guardian prior to jumping.
*Waivers expire after one year

rockinjumpwesterville.centeredgeonline.com/waivers

* I have completed the online waiver (required)

Yes

MUST be filled out before completing this form.

* Parent First Name

* Parent Last Name

* Email

* Phone

Quantity Students - I have Rockin' Jump Socks

They will not accept jump socks from other trampoline parks.

Quantity Students - I need Rockin' Jump Socks

They will not accept jump socks from other trampoline parks.

* Please list the names of student(s) attending below

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

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Card Number

Expiration Date

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Address Line 1

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Comments

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