Attendee Information
Girl Shop Talk begins June 17th and will meet every Wednesday night for 8 weeks.
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.
Format: (000) 000-0000.
Parent/Guardian 1 Relationship
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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.
Format: (000) 000-0000.
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
$
25.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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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