Online Winter Camp Registration – 2019 – Hart to Hart Farm and Educational Center

Camper's Name
First Last
Gender
Date of Birth
Grade in the Fall
T-Shirt Size
- Youth Medium
- Youth Large
- Youth Extra Large
- Adult Medium
- Adult Large
- Adult Extra Large
Parent(s) / Guardian(s) information & BILLING INFORMATION)
Name of Parent(s) / Guardian(s)
First Last
This field is also used as billing information
Email of Parent(s) / Guardian(s)
Address of Parent(s) / Guardian(s)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This field is also used as billing information
Relationship to Camper
Phone (Primary)
Phone (Secondary)
Email
Select Camp Session
Product Name
PLEASE SELECT - $275 per Session OR Deposit of $50.00
2018 Winter farm Day Camp
Additional Comments / Inquiry?
Credit Card Service Charge
$1.75
Credit Card Service Charge*
Total (50% Deposit)
$0.00
Total (Full Amount)
$0.00

Parent(s) / Guardian(s) information & BILLING INFORMATION)