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Youth Camp 2019
Student Information
Student Name
*
First
Last
Shirt Size
*
---------
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Grade Entering
*
---------
6
7
8
9
10
11
12
Grad
Parent Information
Parent Name
First
Last
Phone
*
Email
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
*
------
No
Yes
Student #2 Information
Student Name
*
First
Last
Shirt Size
*
---------
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Grade Entering
*
---------
6
7
8
9
10
11
12
Grad
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
*
------
No
Yes
Student #3 Information
Student Name
*
First
Last
Shirt Size
*
---------
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Grade Entering
*
---------
6
7
8
9
10
11
12
Grad
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
*
------
No
Yes
Student #4 Information
Student Name
*
First
Last
Shirt Size
*
---------
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Grade Entering
*
---------
6
7
8
9
10
11
12
Grad
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
Expiration Date
Security Code
Cardholder Name
Be sure to check the email you provided in the parent section for the camp registration packet.
Name
This field is for validation purposes and should be left unchanged.