Biddy Cheer Camp Registration - St. Peter's Parish & School

Company

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Product Name

Number of Children Registering*

Mother/Guardian*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

Email*

Father/Guardian

First Last

Daytime Phone

Emergency Contact

First Last

Emergency Contact Phone

Are there custody issues we need to be aware of?*

Yes

Please provide detail of the primary custodian of your child along with contact info.*

Payment Method*

Credit Card/PayPal

Pay by Check

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Total

Payment Method

American Express

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Card Number Expiration Date Security Code Cardholder Name