Registration/Payment for SonRock Kids Camp 2024

Please enter information on this form to make payment/register for SonRock Kids Camp 2024 .

Number of Kids *

Email *

Relation To Child/Children: *

Relationship To Child *

Full Name of Parent / Guardian *

Address of Parent / Guardian *

City of Parent / Guardian *

Postal Code of Parent / Guardian *

Phone # of Parent / Guardian *

Mobile # of Parent / Guardian *

Email Address of Parent / Guardian *

Emergency Contact Name *

Emergency Contact Phone # *

Child 1: First Name *

Child 1: Last Name *

Child 1: Gender *

Child 1: Birthdate *

Child 1: Age *

Child 1: Grade (Fall 2024) *

Child 1: Allergies/Medication/Health Concerns

Child 2: First Name *

Child 2: Last Name *

Child 2: Gender *

Child 2: Birthdate *

Child 2: Age *

Child 2: Grade (Fall 2024) *

Child 2: Allergies/Medication/Health Concerns

Child 3: First Name *

Child 3: Last Name *

Child 3: Gender *

Child 3: Birthdate *

Child 3: Age *

Child 3: Grade (Fall 2024) *

Child 3: Allergies/Medication/Health Concerns

Current Church (if attending)

Total Amount

Payment procesing fee

Gross Amount

Payment method

Paypal

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*