2026 PINEYWOODS PRE-TEEN CAMP
June 21 - 24 | Please fill out this form and click submit. If you have more than one student please fill out this for for each student.
STUDENT INFORMATION
Student Name
*
Gender
*
Please select all that apply.
Male
Female
Birthdate
*
Age (as of June 1st)
*
Grade Completed (as of May 2026)
*
T-Shirt Size
*
Please select one option.
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
PARENT INFORMATION
Parent Email
*
This address will receive a confirmation email
Parent Phone
*
$75 deopsit due by Feburary 16th
If you select deposit below a final payment of $310 must be paid to the Church office.
Payment
Full Payment ($310)
Deposit ($75)
Final Payment ($235)
Pay Church Via Check (0)
Full Payment ($310)
Deposit ($75)
Final Payment ($235)
Pay Church Via Check (0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
June 21 - 24
Please fill out this form and click submit. If you have more than one student please fill out this for for each student.
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