Parent or Guardian Information

Emergency Contact Name & Phone Number
Country*
Email*
Confirm Email*
Phone*

Camper(s) Information

Please list all Camper(s) below

Camper 1: First & Last Name*
Camper 1 Age*
Camper 1 Birth Date:*
Camper 1 Gender*
Camper 1 Nickname
Camper 2: First & Last Name
Camper 2 Age
Camper 2 Birth Date
Camper 2 Gender
Camper 2 Nickname
Camper 3: First and Last Name
Camper 3 Age
Camper 3 Birth Date
Camper 3 Gender
Camper 3 Nickname

Camp Hope $35 per Camper

Quantity
Price
Total
Camp Hope Registration

Insert number of children/teens you are registering for Camp Hope.

X
$
35.00=
$
0

Payment Information

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
Additional Comments
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