3/7/22, 21:31 ATC Summer Camp

Important: Your registration is pending until your payment has been

received in full. When it
has been received, you'll receive a new email
confirmation. Please see instructions below to send in your
payment.

Fantastic News! You are register for this year's Summer

Camp. 

Get ready for an amazing experience with Aquatics Training

Cabarete (ATC) by InspireDR!

Your Registration Details Are Below

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3/7/22, 21:31 ATC Summer Camp

Registration
Registration Fee $225.00
fee
(Fee per child for all summer camp
  activities)

Breathnie
Sarina
Name of Child
Severino
Ruben
Age / Edad 8

Date of Birth / Fecha 2014-12-

de Nacimiento 22
Gender / Género Female

1, EL
ACTO, 16,
CALLEJON
DE LA
Address / Dirección LOMA,
SOSUA,
Puerto
Plata
57604 DO

Current Level of Swim

Some
& Lifesaving Skills

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3/7/22, 21:31 ATC Summer Camp

Gregoria
Mother / Madre
Ruben

+1
Mobile / Móvil
8492796603

Occupation /
Maestra
Ocupación

escuela
Workplace / Lugar de
Manuel
trabajo
Gomez P.

Francisco
Father / Padre Nolasco
Martinez
+1
Mobile / Móvil
8498170810

Occupation / Maestro
Ocupación constructor

Workplace / Lugar de
independiente
trabajo

llnesses / Behavior
No
Concerns

Allergies / Alergias? no

Special Diet? no
Health Insurance /
Yes
Seguro de Salud

Company / Compañía Universal

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3/7/22, 21:31 ATC Summer Camp

Bautista
Authorized Person #1
Diaz

Rafaelina
Authorized Person #2 Peralta
Ruben

Only the above stated

Authorized Person(s)
have permission to Breatnie
pickup the following Sarina
child from ATC by
InspireDR:
Authorized Person(s) Yes

Transport (Moto Taxi /

No
Taxi)

Walk by Himself /
No
Herself

Terms & Conditions +

Yes
Waiver

QR CODE NOT AVAILABLE UNTIL A DIGITAL WAIVER HAS BEEN SIGNED BY

EVENT PARTICIPANT OR PARENT/GUARDIAN. Sign
Or copy and share this link
https://Inspirebyaction.regfox.com/s
COPY
TEXT Now

Billing Information

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3/7/22, 21:31 ATC Summer Camp

Order Number TCSMMRCMP-VWM0014

Date 07/03/2022

Name Breathnie Sarina Severino Ruben

1, EL ACTO, 16, CALLEJON DE LA

Address LOMA
SOSUA, Puerto Plata 57604 DO

Payment Method Offline

Please contact us to arrange offline

Payment Instructions payment(s): ATC@InspireDR.org. or
(849) 282-5020. Thank you!

Email fdavidperalta@gmail.com

Phone +1 8492796603

Total $225.00


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