Life Teen Summer Camp at Covecrest Registration

"*" indicates required fields

Student Name*

First Last

Gender*

Female

Male

Home Address*

Street Address City State ZIP Code

Student Grade Level*

Name of Current School*

If "other" please list school*

Parent Name*

First Last

Parent Phone*

Parent Email*

Choose one:

Pay remaining balance (for participants who already paid the deposit)

Pay in full

Life Teen Summer Camp Registration Fee (Remaining Balance)

Price:

Life Teen Summer Camp Registration Fee (Pay In Full)

Price:

Total

Credit Card*

Card Details

Cardholder Name