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6th Grade Camp Payment Form

:: Student's Information:                                       * Required
Student's First Name:*:
Student's Middle Name::
Student's Last Name*:  
Student's School:*:  

:: Bill Payer's Information:
First Name:*:
Last Name*:
Address*:
City*:
State*:
ZIP:*:
Phone Number :   xxx-xxx-xxxx
Email Address*:  
Comments:
 
   
   

:: To finish your order, choose a payment method & click on the button below:

Payment by Check Payment by Credit Card

The first of five payments of $61.55 will be charged today.
Four more payments of $61.55 each will be automatically charged on this date on a monthly basis. 
Total charged to your Credit Card/Bank Account = $ 307.75 commencing on


$ 300.00 + $ 7.75 Convenience Fee if ordered by itself Total = $ 307.75

Total Amount: