Catholic Heart Work Camp 2019 Registration - St. James

Catholic Heart Work Camp 2019 Registration - St. James
June 23 to Jun 28, 2019
Home Base: St. Bridget Catholic School, Richmond, VA


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 Karen Theckston at StJames@boldym.com or 908-280-1865.


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

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

Comments

Please enter any comments here.

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

Wait list - no payment required at this time
Please hit button only once:

973.500.3300
P.O Box 4292, Warren, NJ 07059

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