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Registration/Payment for SonRock Kids Camp 2024
Please enter information on this form to make payment/register for
SonRock Kids Camp 2024
.
Number of Kids
*
--Select--
1 Child - $15
2 Siblings - $30
3 Siblings - $45
Email
*
Relation To Child/Children:
*
--Select--
Parent / Guardian
Other
Relationship To Child
*
Full Name of Parent / Guardian
*
Address of Parent / Guardian
*
City of Parent / Guardian
*
Postal Code of Parent / Guardian
*
Phone # of Parent / Guardian
*
Mobile # of Parent / Guardian
*
Email Address of Parent / Guardian
*
Emergency Contact Name
*
Emergency Contact Phone #
*
Child 1: First Name
*
Child 1: Last Name
*
Child 1: Gender
*
--Select--
Male
Female
Child 1: Birthdate
*
Open the calendar
Child 1: Age
*
Child 1: Grade (Fall 2024)
*
--Select--
Kindergarten
1
2
3
4
5
6
Child 1: Allergies/Medication/Health Concerns
Child 2: First Name
*
Child 2: Last Name
*
Child 2: Gender
*
--Select--
Male
Female
Child 2: Birthdate
*
Open the calendar
Child 2: Age
*
Child 2: Grade (Fall 2024)
*
--Select--
Kindergarten
1
2
3
4
5
6
Child 2: Allergies/Medication/Health Concerns
Child 3: First Name
*
Child 3: Last Name
*
Child 3: Gender
*
--Select--
Male
Female
Child 3: Birthdate
*
Open the calendar
Child 3: Age
*
Child 3: Grade (Fall 2024)
*
--Select--
Kindergarten
1
2
3
4
5
6
Child 3: Allergies/Medication/Health Concerns
Current Church (if attending)
Total Amount
$
Payment procesing fee
$
Gross Amount
$
Payment method
Paypal
Billing Zipcode
*
Credit Card Number
*
Expiration Date
*
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Card (CVV) Code
*
Card Type
*
Visa
MasterCard
Discover
American Express
Card Holder Name
*
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Living Hope Christian Fellowship
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