Massanetta Registration Form
Come join us for an amazing week in the mountains of Virginia. All current 5th-8th Grade youth are eligible for this trip. Dates: Thursday, June 22-Sunday, 25. Cost: $250 (Family Maximum of $400)
Youth One Participant Name
First Name
Last Name
Youth Participant Two Name (if applicable)
First Name
Last Name
Youth Participant One e-mail Address
example@example.com
Youth Participant Two e-mail Address (if applicable)
example@example.com
Caregiver Name
First Name
Last Name
Caregiver e-mail Address
example@example.com
Caregiver Phone Number
Please enter a valid phone number.
T-Shirt Size(s)
Special Dietary Needs/Restrictions
Registration Fees: If you choose to pay by check, don't select either of these boxes, and select Submit below.
prev
next
( X )
Individual Massanetta Registration
Select this option to pay for one youth participant. This covers the cost of conference registration fees, housing, and all food once we arrive at Massanetta.
$
250.00
Family Massanetta Registration
Select this option to pay for more than one youth participant. This covers the cost of registration fees, housing, and all food once we arrive at Massanetta.
$
400.00
Credit Card
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform