Leadership Camp Registration | Pacific Crest Youth Arts Organization

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CHOOSE YOUR CAMP

Make Your Selection*

Fee

STUDENT INFO

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Please enter your personal email address. Do not use a parent email or school email.

Enter Email Confirm Email

Phone*

Sex Assigned at Birth*

Gender*

Pronouns

Ethnic Category

Birthdate*

mm/dd/yyyy

Age*

PARENT/GUARDIAN INFO

Parent or Guardian Name*

First Last Suffix

Parent or Guardian Email*

Enter Email Confirm Email

Parent or Guardian Phone*

REGISTRATION

Name of School*

School City and State*

Your Position*

T-Shirt Size*

PAYMENT

Promotional Code

Total Charge

Option to Pay by Check

NOTE: Paying by check is reserved only for school, district, or booster club check. Individual registrations must pay by credit or debit card.

We will pay by school, district, or booster club check

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Cardholder Email*

For payment receipt.

Enter Email Confirm Email

Card Holder Billing Address

Same as address entered above

Street Address City State / Province / Region ZIP / Postal Code Country

Comments

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