Village @ Home

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1st Camper

Name

*

Age

*

Sex

*

Please select one option.

Male Female

2nd Camper

Name

Age

Sex

Please select one option.

Male Female

3rd Camper

Name

Age

Sex

Please select one option.

Male Female

4th Camper

Name

Age

Sex

Please select one option.

Male Female

Parent/Guaridan Information

Parent/Guardian name

*

Email

*

This address will receive a confirmation email

Phone

*

Which parish are your from? (Church name and city)

*

Emergency Contact

Name

*

Relationship to camper(s)

*

Phone

*

Additional Information

Check all dates your campers will be in attendance

*

Please select all that apply.

Friday 11/1 Sat 11/2 Sun 11/3

Please make note of any limitations your camper(s) may have in participating in the program

Any other information you think we should have

Will you be attending the parent session with Fr. Anthony?

*

Please select one option.

Yes No

Do you need a place to stay overnight? (For out of town guests)

*

Please select one option.

Yes No

Payment

The amount is $20 per camper. If you are unable to pay this, we would rather your child be able to come, so please speak to Fr. Joseph (frjoseph@stgeorgecharleston.org).

Payment

1 Camper ($20.00) 2 Campers ($40) 3 Campers ($60) 4 Campers ($80)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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