Pine Valley Summer Camp Payment Processing
Parent/Guardian Name
*
First Name
Last Name
What is your relationship to camper(s)?
Parent
Aunt/Uncle
Grandparent
Other
Please explain your relationship to camper(s):
Camper's Name
*
First Name
Last Name
Are you paying for another camper?
*
Yes
No
2nd Camper's Name
First Name
Last Name
Are you paying for another camper?
Yes
No
3rd Camper's Name
First Name
Last Name
Are you paying for another camper?
Yes
No
4th Camper's Name
First Name
Last Name
My Products
*
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Kids' Camp Registration Fee
$
35.00
Number of Children Attending this Program
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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26
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28
29
30
31
32
33
34
35
36
37
38
39
40
Choose Payment Tier
Tier 1
Tier 2
Tier 3
Crossroads Registration Fee
$
90.00
Number of Children Attending this Program
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Choose Payment Tier
Tier 1
Tier 2
Tier 3
Mini Camp Registration Fee
$
15.00
Number of Children Attending this Program
1
2
3
4
5
6
7
8
9
10
Choose Payment Tier.
Tier 1
Tier 2
Tier 3
Transportation ($5 for EACH camper)
$
5.00
Number Needing Transportation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
ACAC Term 6 Registration
$
50.00
Number of Children Attending this Program
1
2
3
4
5
6
7
8
9
10
Choose Payment Tier
Tier 1
Tier 2
Remaining Balance
CIT Registration Fee
$
45.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
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Submit
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