GENERATE Youth Camp (Student Registration)

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Student Name

*

Birthdate

*

Choose One

*

Please select one option.

Male Female

Grade (2023-2024)

*

Please select one option.

6th 7th 8th 9th 10th 11th 12th

Parent Phone

*

Student Phone

Address

*

Shirt Size (adult sizes)

*

Please select one option.

Small Medium Large XL 2XL 3XL

Contact E-mail

*

This address will receive a confirmation email

Student Fee

Full amount ($400) Deposit (non-refundable) ($200) Paying with cash or check or account at church ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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