Bounce for Autism- Registration
NSASA Fundraiser-- Monday, October 8th, 2018, from 9:15am to 12pm

For a minimum $25 donation, each child registered will have access to our exclusive jump time from 9:15am to 11am, can enjoy some bagels from breakfast and pizza for lunch, and can stay and jump until 12pm!

Please fill out the form below for each individual jumping. Each jumper must raise a minimum of $25. Parents are not required to jump, but if they are going to jump, they must register as a jumper below.

This year's Top 3 fundraisers will receive a prize from NSASA!
First Place will receive 4 tickets to Splish Splash and 4 lunch vouchers for the 2019 Season
Second Place will receive 3 tickets to Splish Splash and 3 lunch vouchers for the 2019 Season
Third Place will receive 2 tickets to Splish Splash and 2 lunch vouchers for the 2019 Season

Thank you for supporting NSASA's family programs! If you have any questions, email Michele at Lumardi@verizon.net

Parent Name *
Your answer
I am aware that this event is a fundraiser for NSASA's family programs. All proceeds from this event will go toward funding future NSASA events. Minimum donation for this event is $25 per jumper.
First/Last Name of Jumper #1 *
Your answer
Age of Jumper #1 *
Your answer
First/Last Name of Jumper #2
Your answer
Age of Jumper #2
Your answer
First/Last Name of Jumper #3
Your answer
Age of Jumper #3
Your answer
First/Last Name of Jumper #4
Your answer
Age of Jumper #4
Your answer
If there are any additional jumpers, please include their information here.
Your answer
What is your email address? *
Your answer
Please confirm your email address. *
Your answer
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