HS Camelback Overnight

Camelback Overnight Registration

"*" indicates required fields

Parent Name*

First Last

Parent Phone*

Parent Email*

Enter Email Confirm Email

Student's Name*

First Last

Student's Phone Number*

Student's Email*

Enter Email Confirm Email

Student's Gender*

Male

Female

Student's Grade*

10th

11th

Does the student have any allergies? If yes, please explain. If no, please write No.*

Does the student have any medical conditions we should be aware of? If yes, please explain. If no, please write No.*

Please list your rooming request (maximum of 4 requests)*

I give consent for my child to attend this trip*

Yes

Student Price*

Price:

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

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