Name:
Age:
Address:
E-mail:
Parent or guardian:
Phone number:
Skating instructor:
Monday program: $420.00
Thursday Program: $405.00
Friday Program: $390.00
C.C. #
EXP date:
CVC Code:
*Note* all credit card payment are subject to a 4% processing fee
Checks made payable to – Community Recreational Center
Please drop of form or mail to
Community Recreational Center
1767 East shore drive
Ithaca, NY 14850