Catholic Heart Work Camp 2021 - Dover, DE

Dover, DE
June 27 - July 2, 2021

Dover is open to those entering the 9th grade in the fall of 2021 and older.

You are now registering for the wait list! We will contact you in the order you register if a spot becomes available for you.

 If you will be 18 or older by June 26, 2021, you are required to attend a Protecting God's Children course and undergo a background check through the diocese in order to attend the trip. Reach out to your Youth Minister for more information.

Once you submit this form, you will then receive a confirmation email with further instructions. If you do not receive that email within 24 hours of registration, please check your spam folder and then contact Allison Provinsal at Aprovinsal@Fiatventures.com


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)
*Gender
*Birthdate (mm/dd/yyyy)
*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

Emergency Contact Information

*First and Last Name
*Relationship
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Additional Information

Parish
Will you be 18 or older by Jun 27, 2021?

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

If a spot becomes available for you, you can pay at that time.
Please hit button only once:

908.500.3300
P.O Box 4292, Warren, NJ 07059

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