Camp Breakaway

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All personal information provided will be kept strictly confidential

* These fields are required

1 Welcome

2 Price/Lodging Options

3 Guest Details

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Comments or Special Needs *	Please provide us with any special needs you and your party may have regarding housing accommodations. We will do our best to honor all requests, based on availability. Please contact us with any questions.
Birth Date *
Sex *
Special Diet *	Please let us know if you, or anyone in your party choses to follow a special diet. We will do our best to accommodate all dietary needs, based on food availability and pricing. Please contact us with any questions.
Food Allergies	Please list any food allergies you or anyone in your party have. We will do our best to provide meal options that will accommodate your needs, based on food availability and pricing.
Emergency Contact Info *
Medical Issues *	Please let us know if you or anyone in your party have any serious medical issues that we need to be aware of.
Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone Number *
T-Shirt Size(s) *	If you are registering multiple children, please list the quantity of each size needed for your children
Home Parish	Please list the parish that your child attends most often

4 Payment