Catholic Heart Work Camp 2019 Registration - Hartford

Hartford, CT
July 7 to July 12, 2019
Home Base: East Catholic High School

The trip is currently full and a wait list has been opened.  Please still sign up for the wait list!  As soon as a spot becomes available, you will be contacted.  For more information, please contact Allison Provinsal at Aprovinsal@fiatventures.com or 973-500-3300 ext. 708.

Once you submit this form, you will receive a Confirmation email.  We hope to be in touch soon with good news!


Participant's Information

*First Name
*Last Name
*Address
Apartment If Applicable
*City
*State
*Zip Code
*Email
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Grade
*Shirt Size

Parent's Information

First Name
Last Name
Email
Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Health Information

Health Insurance Company
Health Insurance Policy Number
*Known Health Issues
*Allergies and any medication you will be taking during the event

Additional Information

Parish
Will you be 18 or older by Jun 28, 2019?

Comments

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Payment


Promo Code: (if you have been given a promo code and are authorized to use it please enter it here and click update)



Total Due Now:
$0

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973.500.3300
P.O Box 4292, Warren, NJ 07059

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