Cheick Dialo Camp 2019

 

Step 1: Submit your information

 

Child's First Name *

Child's Last Name *

Date of Birth *

Age *

Gender *

• Male
• Female

Grade *

Any Allergies, Medications, or Medical Conditions? If so, please list:

Parent First Name *

Parent Last Name *

Street Address *

Town *

State *

- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Contact Phone *

Email Address *

Emergency Contact & Phone Number *

Submit

 

Step 2: Payment

To complete your registration, please click the “Buy Now” button below to pay the registration fee. You will be redirected to our PayPal page for secure payment.
 

Full Payment

Full Payment $300.00 USDNonrefundable Deposit $150.00 USD