The Putnam Children's Discovery Center
 

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Text Box: REGISTRATION FORM  Mail: PCDC PO Box 222 Carmel, NY 10512 or if paying by credit card you can fax to (845) 276-2078  Child’s Name ______________ Age ____ Phone ___________ Email ____________________ Address ___________________________________________ __ Please send me Birthday Party Information __ I am adding a donation of $ _______ ___ I am a PCDC member ( pay PCDC pricing)  Membership Expires: ____/____/____  **To pay the lower “PCDC” price add $25 for family membership and your membership is valid with discounts for everyone in your  immediate family for 1 year.  Please make checks payable to PCDC To pay by credit card, your address above must match your billing address and MUST include town, state & zip        We accept VISA & MASTERCARD Name on Card: ____________________________________   _____________/_____________/____________/_____________   Exp: _____/_______   Signature: ____________________________________________________  Program Title: _________________________ Dates: __________________ Time _________ Cost $ _____ Program Title: _________________________ Dates: __________________ Time _________ Cost $ _____ Please note to sign up for a play you must have taken an acting course: Acting Course taken with PCDC that makes you eligible __________________________ ( please note this cannot be a play)  Please note there are no refunds unless PCDC cancels the class. Assume you are in unless you hear from us. To avoid distractions, all classes are drop off except Mommy & Me  Questions (845) 276-2076 ext. 307

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