2024 Summer Camp Reservation Deposit

July 8-12, 2024 | Please fill out this form, include your payment information, and submit to reserve a spot for your student(s) 2024 Summer Camp.

Please reach out to Laurie Newman at studentpastor.org with any questions.

Parent/Guardian Information

Name

This address will receive a confirmation email

Cell Phone

Address

Student Information

Student 1 Name

Address

Current Grade Level

Please select one option.

7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Student 2 Name

Address

Current Grade Level

Please select one option.

7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Student 3 Name

Current Grade Level

Please select one option.

7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Address

Payment Information

In order to reserve a spot for your student(s), we must receive a non-refundable deposit of $75.00 per student.

Once your deposit(s) is processed, you will receive a link to register with Piney Woods Encampment.

If you have questions, please reach out to Laurie Newman at studentpastor@sterlingwood.org.

Deposit Payment

1 Student ($75.00) 2 Students ($150.00) 3 Students ($225.00) Already Paid Directly (Your Spot will be reserved once payment is confirmed.) Please leave the Amount blank. ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July 8-12, 2024

Please fill out this form, include your payment information, and submit to reserve a spot for your student(s) 2024 Summer Camp.

Please reach out to Laurie Newman at studentpastor.org with any questions.

2024 Summer Camp Reservation Deposit

Description

Please Fix the Following