Bobby Cremins Day Camp One

*Registration for Day Camp One has now closed

Choose Your Payment Option

Pay for my child to attend camp.
Pay for another child to attend camp (Gift Certificate).

Congratulations! The registration you process online today will send one lucky child to camp! Before you start filling out the registration form, we just need to know how you would like your gift certificate delivered:
^{Click here for a sample gift certificate.}

Please email a customized gift certificate in .pdf format. Enter the e-mail address in the box below.

(no additional charge)

Please mail a customized printed gift certificate to:

^{Full Name}
^Address
^{Address Line 2}
^City	^{Billing State}
^{Zip Code}	^Country

(additional $5.00 fee)

Billing Information

Name as it appears on credit card

^{First Name}

^{Last Name}

Billing Address

^Address
^{Address Line 2}
^City	^{Billing State}
^{Zip Code}	^Country

Telephone Numbers

Home Number

Work Number

Cell Number

E-Mail Address

Credit Card Information

Type: Visa Master Card American Express Discover

^{Credit Card Number}
/ ^{Expiration (mm/yyyy)}

Parent / Guardian Information

Check this box if the following information and your billing information are the same.

Name

^{First Name}

^{Last Name}

Billing Address

^Address
^{Address Line 2}
^City	^{Billing State}
^{Zip Code}	^Country

Telephone Numbers

Home Number

Work Number

Cell Number

E-Mail Address

Camper Information

Camper's Name

^{First Name}

^{Last Name}

Camper's Age

Camper's Birthday

/ /

Camper's Height

Camper's Weight

^Weight

Camper's Grade

^{2010 - 2011 school year}

Name Of School

Camper's E-Mail Address

Authorization

By clicking on the box to the left and entering my name and today's date into the fields below, I agree to pay the full amount for camp chosen above.

^{Full Name}

^Date

Choose Your Payment Option

Billing Information

Name as it appears on credit card

Billing Address

Telephone Numbers

E-Mail Address

Credit Card Information

Parent / Guardian Information

Name

Billing Address

Telephone Numbers

E-Mail Address

Camper Information

Camper's Name

Camper's Age

Camper's Birthday

Camper's Height

Camper's Weight

Camper's Grade

Name Of School

Camper's E-Mail Address

I would like to room with...

Authorization