CIY MIX

Student Name

Parent Name

This address will receive a confirmation email

Phone

Address

School

Grade

Payment 75.00

How did you hear about Summer Camp?

Church Friend Social Media Mailer

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 28-July 1st

This registration form is for Middle School students. This event will be held at Biola University in La Mirada, CA from June 28th-July 1st.
Full price is $300 per student.

CIY MIX

Description

Please Fix the Following