Student's Name First Last Student's Age*-1112131415161718Current Grade*-6th7th8th9th10th11th12thGender*-FemaleMaleRoommate Request Does your student require any medications or special needs?Will you student be leaving at all during the weekend?Parent Name* First Last Parent Cell #*Parent Email* Payment Options* Credit/Debit Card Payment Scholarship Payment Optional Scholarship Donation If you would like to help provide funds for a student scholarship, please insert the amount above.Scholarship Code If you would like to request a scholarship please contact Taylor Sallade at TaylorS@riverchaseumc.orgGrunt Week Fee Price: Grunt Week Fee Price: Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
