Big Wheel Before/After School Program

2022-2023 Registration Form 1 PDF

2022-2023 Registration Form 2 PDF

Step 1 of 6

Child's Name(Required)

First Last

Date Of Birth(Required)

Age(Required)

Please enter a number from 1 to 17.

Sex(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Best Contact #(Required)

List ALL Allergies, medications, and/or special needs

Start Date(Required)

Session(Required)

Child Lives With(Required)

Parents Martial Status(Required)

Donation Request Form

The Big Wheel enjoys helping our community raise funds for their special events and we appreciate the groups who also frequent our facility and book parties for their schools and churches. *mailing fee $2.50

Name(Required)

First Last

Email(Required)

Please tell us in detail, what you would like from us in terms of a donation?(Required)

Name of Event(Required)

Todays Date(Required)

What is the date of your Event?(Required)

Your position with the organization(Required)

Please list the best contact phone number for you(Required)

Organization Name(Required)

Organization's Primary Phone number(Required)

Please list any other email address associated with the Organization

Please provide the Organization's Website Address

Organization's Street Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please select best answer:(Required)

Please provide full mailing address and details if you requested the donation items to be mailed and if it is DIFFERENT than the address listed above.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other Important Information

If your organization has a Tax ID number, please enter it here

CAPTCHA

Planning a Fundraiser?

$475.00 for two hours of skate rental extra. If you are a non-profit organization wishing to raise funds or just have a special event planned please let us know and we will try our best to make your event special. Available Monday – Thursday.

Name(Required)

First Last

Email(Required)

Phone(Required)

How much money are you trying to raise?(Required)

Have you ever hosted or attended a group event at our facility before?(Required)

Please explain in as much detail as possible, the purpose of your fundraiser - who or what is it for? What are you trying to accomplish?(Required)

For planning purposes, how many guests are you hoping to participate in your Fundraiser(Required)

What dates are you interested in? Please provide several options unless there is only one specific date that will work(Required)

Starting time of event(Required)

:

Ending time of event(Required)

:

What is the budget for your Fundraiser?(Required)

Are you considering holding your Fundraiser at our facility or do you have another location in mind?(Required)

When you do expect to make a decision about where and when your Fundraiser will be held?(Required)

Who will be in charge of your Fundraiser?(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who will be invited to your Fundraiser?(Required)

CAPTCHA

Big Wheel Before/After School Program

2022-2023 Registration Form 1 PDF

2022-2023 Registration Form 2 PDF

Parent/Guardian Information #1

Parent/Guardian Information #2

Emergency Contact/Authorized Pick-Up

Emergency Contact #2

Emergency Contact #3

Emergency Contact #4

Signatures

(570) 424-5499

Book a party

Hockey Sign Up

Download Our Calendar

Donation Request Form

Fundraiser

Employment Application

Rent The Main Rink

Adult Roller Hockey

Youth Roller Hockey

Big Wheel Before/After School Program

Parent/Guardian Information #1

Parent/Guardian Information #2

Emergency Contact/Authorized Pick-Up

Emergency Contact #2

Emergency Contact #3

Emergency Contact #4

Signatures

Book a party

Hockey Sign Up

Adult Roller Hockey

Youth Roller Hockey

Donation Request Form

The Big Wheel enjoys helping our community raise funds for their special events and we appreciate the groups who also frequent our facility and book parties for their schools and churches. *mailing fee $2.50

Planning a Fundraiser?

$475.00 for two hours of skate rental extra. If you are a non-profit organization wishing to raise funds or just have a special event planned please let us know and we will try our best to make your event special. Available Monday – Thursday.

Employment Application

Rent the Main Rink

$10.00 Per person (minimum of 50 people) plus skate rental. We will have our DJ run this two hour event for your group and cater to any games, music or special requests you might have.