Winter Camp Credit Card Payment Form
Participant Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
*Online processing fee included*
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December 22nd & 23rd 1PM-5PM
$
230.00
Quantity
1
2
3
4
5
6
7
8
9
10
December 29th & 30th 1PM-5PM
$
230.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: