Belfast Celtic Summer Camp Registration form

Parent/Guardian details.

First Name:(Required)

Surname:(Required)

address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

1st Child Name:(Required)

Mobile:(Required)

Date of Birth:(Required)

Do you have Medical History?

Medical History:(Required)

Drop files here or

Max. file size: 256 MB.

Full Payment per Child(£50.00) | Payment Plan Deposit Per(£20.00)(Required)

Full fee £50

Deposit GB£20 bal by June 10th.

Total

Terms And Conditions(Required)

Credit Card(Required)

American Express

Discover

MasterCard

Visa

JCB

Maestro

Card Number

Expiration Date

Security Code Cardholder Name