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Summer Special

Special Deal on Sale Now!
SUMMER SPECIAL MEMBERSHIP - $99

Unlimited visits from June 1 - September 30
Up to 3 family members per visit; registered caregiver may be included
In October, sign up for any one of our regular memberships and receive a $24 discount

To purchase a 10-Visit Pass instead, please click here.

Optional Please add a tax-deductible donation to your monthly payment to support Habitot (fill in amount):

Special Code (optional):

How Would You Like to Receive Your Membership Pass?

Please mail my membership pass. I will pick up my membership pass at the Front Desk on my next visit. This is a gift membership pass. Please mail pass to billing address. This is a gift membership pass. Please mail pass to member/recipient family.

PLEASE PROVIDE COMPLETE INFORMATION BELOW

Member/Recipient Registration (living in household) Parent First Name: Parent Last Name: Parent First Name: Parent Last Name: Email (required) (we do not share email lists):

Please check if you do not wish to receive monthly Totmail e-newsletter

If different from billing:

Home Address: Home City: Home State: Home Zip:

Caregiver/Authorized Adults

Caregiver First Name: Caregiver Last Name: Grandparent First Name: Grandparent Last Name: Grandparent First Name: Grandparent Last Name:

Emergency phone number (required):

Children Living in Household

Child name 1:	Child birthdate mm/dd/yy:
Child name 2:	Child birthdate mm/dd/yy:
Child name 3:	Child birthdate mm/dd/yy:

Billing Information

First Name:

Last Name:

Address:

City:

State:

Country:

Zip:

Email:

Phone:

Credit Card

Card Number:

Expiration Date:

CVV: ()

Questions? email us at habitot.memberships@gmail.com.

Habitot is a non-profit 501(c)3 organization with tax ID number 94-3191605. All donations are tax deductible.