Page 13 - 2021GradeSchoolCamps

2021 Cor Jesu Summer Camp Registration

Register online at www. corjesu.org/camps. Or, complete the form below and mail it
with a check payable to Cor Jesu Academy; credit cards also accepted.
Mail by May 15, 2021, to Cor Jesu Academy; Attn: Summer Camps; 10230 Gravois Road;
Saint Louis, MO 63123. Registrations postmarked after May 15, 2021, will be
charged a $25/per camp late fee.

CAMPER’S NAME

ADDRESS

CITY STATE ZIP

PHONE E-MAIL

GRADE IN 2021-22 SCHOOL
PARENTS’ NAME:
MOM DAD
WORK PHONE:
MOM DAD
CELL NUMBER:
MOM DAD
EMERGENCY CONTACT:
NAME PHONE NUMBER
2021 Camps Attending:
1. $
CAMP NAME FEE
2. $
CAMP NAME FEE
3. $
CAMP NAME FEE
4. $
CAMP NAME FEE
Camp T-shirt Size (please check one):
m Youth L m Adult S m Adult M m Adult L $ (no extra charge)

Late Fee (for registering after 5/15/21 $25.00 x ___________ $
NO. OF CAMPS
m A check payable to Cor Jesu Academy is enclosed. Total $

m Amer. Express m Discover m Visa m MasterCard

CARD NUMBER SECURITY CODE

SIGNATURE EXP. DATE 13