Discount Request Form

Breakaway Camp Discount Request

To be filled out by the Camp Coordinator of the attending Church
Discounts, such as Credentialed AG Ministers Child ($30/Child), Royal Rangers Chartered Member ($10/Child), Mpact Girls Chartered Member ($10/Child), and Fine Arts Merit Winners ($25/recipient of award coupon) are exclusively available to qualifying individuals. Please note that Royal Rangers (RR) and Mpact discounts apply only to churches chartered for the 2023/24 season. Verify with your church leadership to confirm chartered status before requesting these discounts.

Fine Arts Merit Coupon holders must surrender the Merit Award Coupon at the time of payment to receive this discount. Please include this coupon with your church check.
Camp Coordinator Name*

First NameLast Name
Email*

Confirmation Email
Church City*
Church Name*
Discount Requests
Please list eligible students below. Click "Add Row" to add more students:*
Should be Empty:

Breakaway Camp Discount Request