Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Parent(s) Name *

First Name

Last Name

Parent 1 Cell *

(###)

###

####

Parent 2 Cell

(###)

###

####

I understand that the price of the fall retreat is $85 for first student and $5/10 off each additional student in our family. *

2 kids = $85 and $80 3 kids = $85, $80, and $75

Yes

I understand my student's spot is not saved until payment is received. *

Space is LIMITED as camp is FULL. We will start a waiting list if needed when we run out of beds.

Yes

I will pay my deposit:

Online ---- Youth Events - Non-Charitable in the Funds dropdown menu

Cash or Check in offering box with RSM Camp in memo

I understand I need to complete the 2 forms below for each of my students.

Yes