.

.

Youth Camp 2019

Student Information
Student Name*
First Last
Shirt Size*
Grade Entering*
Parent Information
Parent Name
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Payment Options:*
- Full Payment - $200
- Deposit - $60
Deposit does NOT lock in the price. ie. If you start registration on January 1st but do not finish paying until April 1st the total owed increases to $160.
Add Another Student*

Student #2 Information
Student Name*
First Last
Shirt Size*
Grade Entering*
Payment Options:*
- Full Payment - $200
- Deposit - $60
Deposit does NOT lock in the price. ie. If you start registration on January 1st but do not finish paying until April 1st the total owed increases to $160.
Add Another Student*

Student #3 Information
Student Name*
First Last
Shirt Size*
Grade Entering*
Payment Options:*
- Full Payment - $200
- Deposit - $60
Deposit does NOT lock in the price. ie. If you start registration on January 1st but do not finish paying until April 1st the total owed increases to $160.
Add Another Student*

Student #4 Information
Student Name*
First Last
Shirt Size*
Grade Entering*
Payment Options:*
- Full Payment - $200
- Deposit - $60
Deposit does NOT lock in the price. ie. If you start registration on January 1st but do not finish paying until April 1st the total owed increases to $160.

Is this your first time attending camp?*
- Yes
- No
Who referred you?*

Total
$0.00
Coupon
Billing Address*
Same as previous

Street Address Address Line 2 City State ZIP Code
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Be sure to check the email you provided in the parent section for the camp registration packet.
Phone
This field is for validation purposes and should be left unchanged.

Go back to the Countryside website Go back