Youth Camp Registration

June 10 - June 13 | Registration Deadline: May 10

Final Payment Due: June 1

Date:
June 13

Cost:
$250

Registration
$50

Student Information

Student Full Name

*

Grade (Current)

*

Age

*

T-Shirt Size

*

Please select one option.

YS YM YL S M L XL

Allergies/Medical Conditions:

*

Parent Guardian Information

Parent/Guardian Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Pay Online

Payments may be made here online, through the Tithely giving portal, or by cash/check turned in to Pastor Jeremiah.

You may register today without making a payment by entering "0" in the payment option box.

Payments (drop down options)

No Payment at this time (0) Registration ($50) Partial Payment (enter amount)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 10 - June 13

Registration Deadline: May 10

Final Payment Due: June 1

Please Fix the Following

Close