Online Family Camp Registration

Primary Contact (Person making registration payment)

First Name*

Last Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Phone Type

Email*

Please complete the section below for the entire party including primary contact full names, birth dates, relationship to primary contact and any restrictions.*

Name	DOB	Relationship to Primary Contact	Allergies, Medical, Physical or Dietary Restrictions

Reservation Details

I would like to attend session(s): (Hold down control key to select multiple sessions.)

I/We Wish to rent a:

I/We Wish to rent a second:

If you are interested in renting more than 2 cabins or tents, please outline your request below and we will contact you for details

Arrival and Departure

Arrival Date

Departure Date

Total Amount Due

50% Deposit Enclosed

Balance is due April 1 Click here for Rate Sheet Your remaining balance is due by April 1 in the form of check or money order. The deposit is non-refundable in case of withdrawal, except in the event of illness. Guests who cancel after April 1 will be responsible for 100% of the total fee if the resulting vacancy is not filled at the time of cancellation.

Payment Information

Credit Card*

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Info*

Credit Card Billing Address is the same as Primary Contact Address
Credit Card Billing Address is different than Primary Contact Address

Credit Card Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

$0.00

Additional Information

Important! Please indicate below, as necessary, for each member of your group, any allergies, special medical, physical or dietary circumstances of which we should be aware as your host!

Email

This field is for validation purposes and should be left unchanged.

Test name

Position title

Primary Contact (Person making registration payment)

Reservation Details

Arrival and Departure

Payment Information

Test name

Position title

Online Family Camp Registration

Primary Contact (Person making registration payment)

Reservation Details

Arrival and Departure

Payment Information

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