Registration
We are celebrating Black Friday, Small Business Saturday & Cyber Monday at Jump Start! - NOW EXTENDED THROUGH DECEMBER 25, 2018! Gift your child with an experience this Christmas! Purchase a $50 Gift Certificate and receive a BONUS $5 Gift Certificate OR purchase a $100 Gift Certificate and receive a BONUS $15 Gift Certificate! All Gift Certificates will be mailed out once payment has cleared Questions? Email Info@jumpstartfun.com or call 309-692-5867!
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*