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INACTIVE Winter Camp

Winter Camp Registration

Click HERE for full flyer
Child 1
Full Name

First Name Last Name
Birth Date

Month Day Year
School Attending
Grade Attending
T-Shirt size
Child 2
Full Name

First Name Last Name
Birth Date

Month Day Year
School Attending
Grade Attending
T-Shirt Size
Parents Information
Father's Name

First Name Last Name
Father's Cell

Area Code Phone Number
Father's E-mail
Mother's Name

First Name Last Name
Mother's Cell

Area Code Phone Number
Mother's E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please select the days your child will be attending.

Cost: $70 per day or $300 per week
Please select

Monday, December 28, 2015 Tuesday, December 29, 2015 Wednesday, December 30, 2015 Thursday, December 31, 2015 Friday, January 1, 2016

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Total to charge:*
Comments:
Should be Empty:

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