Summer Camp Late Pick-Up Payment Form

Required

Late Pick-Up Payment Form

Student Namerequired

First Name

Last Name

Family Email Addressrequired

Parent/Guardian Name required

First Name

Last Name

How many late pick-up days are you paying for?requiredPlease select up to 1 choice

1 Day ($75.00)

2 Days ($150.00)

3 Days ($225.00)

4 Days ($300.00)

Please select up to 1 choice

Please select a payment typerequired

Stripe - Credit Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year