Attendee Information
Name
*
First Name
Last Name
Age:
*
Please Select
13
14
15
16
Does the attendee have any allergies?
*
Yes
No
Please list attendee's allergies.
*
How did you hear about Girl Shop Talk?
Please Select
Cornerstone Christian Church
Dawn Treader Christian School
Emergence
Grace Redeemer Church
Hawthorne Gospel Church
King of Kings Worship Ministry
Lighthouse PRC
New Destiny
Street Hope Alive
The Chapel
Other
If other, please explain.
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Parent or Guardian Information
Parent/Guardian 1 Name:
*
First Name
Last Name
Parent/Guardian 1 Email
*
example@example.com
Parent/Guardian 1 Phone
*
Please enter a valid phone number.
Parent/Guardian 1 Relationship
*
Parent/Guardian 2 Name:
*
First Name
Last Name
Parent/Guardian 2 Email
*
example@example.com
Parent/Guardian 2 Phone
*
Please enter a valid phone number.
Parent/Guardian 2 Relationship
*
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Registration Fee
Select one.
*
I will pay the $25 registration fee now.
I'd like to request a scholarship.
My Products
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Girl Shop Talk Registration Fee
Fee is per camper for one week only.
$
25.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Legal Guardian Name
*
First Name
Last Name
Signature
*
Newsletter Email List
Please add me to SHM's newsletter email list to receive quarterly updates.
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