SNU Homepage
Crimson Camp Registration
Parent Information
Father Name:
Mother Name:
Mother Cell Phone:
Father Cell Phone:
Home Phone:
Street Address:
City:
State:
Zip Code:
Email:
In Case of Emergency:
Please list the name of another adult who would have your permission to pick up your child in case of an emergency. A local (OKC area) contact is preferred.
Name:
Relationship to Child:
Phone:
Child 1
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Child 2
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Child 3
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Child 4
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Child 5
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Child 6
First Name:
Last Name:
Gender:
Birthdate: //
Age (as of Nov. 9, 2013):
T-Shirt Size:
List all allergies
or medical needs:
Payment Method
Amount:
Name of Cardholder:
Billing Street Address: (Exactly as it appears on your credit card billing statement.)
Billing Zip:
Card Number: (without spaces)
Expiration Date:
We accept:
   MasterCard®

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