Charger for a Day Registration

At the bottom of this form, please select TWO visit date options between October 3, 2016 and April 21, 2017. All attempts will be made to satisfy your first choice, but in the event of a conflict the second choice may be used.

    STUDENT INFORMATION

    This is a required question
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    PARENT/EMERGENCY CONTACT INFORMATION

    Please include AT LEAST one phone number where you can be reached in the event of an emergency.
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    CHARGER FOR A DAY - VISIT DATE

    Please select a date between October 3, 2016 and April 21, 2017.
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    This is a required question