| Shrine Mont CFO Registration Application | ||||||
| Compl. Grade | Full Time? | First Time | ||||
| Last Name | First Name | (M/F) | Birthdate | As of this June | (Y/N) | Camper? |
| Address: | ||||||
| Phone: | ||||||
| Email: | ||||||
| Special Needs/Educ?: | ||||||
| If Part Time, Please Indicate Arrival Departure Dates and Meals: | ||||||
| Registration Rates: | ||||||
| Adult (18+): $50 each | ||||||
| Youth (13-17): $20 each | ||||||
| Child (4-12): $15 ea. | ||||||
| Child (0-3): $0 | ||||||
| Ministers & Spouse: $30 ea. | ||||||
| Family Maximum: $120 | ||||||
| Single Parent Fam. Max: $70 | ||||||
| Registration Must Be Accompanied By Registration Fee, Checks Payable To Shrine Mont C.F.O. | ||||||
| Send Registration Form & Fee To: Cheryl Finnegan, 19411 Shelburne Glebe Road, Leesburg, VA 20175 | ||||||