My Organization

Hermann-Grima + Gallier Historic Houses

820 St Louis St. | 1132 Royal St.

  New Orleans, LA 70112 | New Orleans, LA 70116

(504) 525-5661

info@hgghh.org

Courtyard Camp Registration

Summer Session:

August 5 - 9, 2019

9am - 3pm

Quantity
Price
Total
Member Camper

HGGHH Family Level Membership only

X
$
300.00=
$
0

Nonmember Camper
X
$
350.00=
$
0

Final Total:
$
0

Camper Information

Please fill out separate forms for multiple campers.

Child's Name
Child's Date of Birth
Child's Age
Grade Level (current or completed)
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Cell
Please list any medical issues.
Please list any allergies.
Please list any behavioral issues.
Medical Insurance Company and Policy #

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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