Crossings
Cedarmore, KY
May 30th - June 3rd
Students Currently in 7th - 12th Grade

Student Information

Name

*

Email

*

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Phone

*

Address

*

Current Grade

*

Please select one option.

7th 8th 9th 10th 11th 12th

Gender:

*

Please select one option.

Male Female

Allergies

*

Please select all that apply.

No Yes

If Yes, please list:

Release

Please click here to complete SRBC's Release Form in order for your child to participate in Crossings.

Parent/Guardian Information

Name

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Payment

Crossings 2024 Expense

Full Camp Price ($250) Remaining Cost After Desposit ($200)

Amount

Total camp cost is $250 per participant. Total Amount Due May 15th.

$250 covers transportation, lodging, meals at camp, and teaching materials.

Students will need addtional money for one meal on the way to camp and one meal on the way home from camp, as well as any spending money they may want while at camp.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Crossings
Cedarmore, KY
May 30th - June 3rd
Students Currently in 7th - 12th Grade

Please Fix the Following

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