Summer 2025 Template

WHERE: Clearwater Cove!

WHEN: June 20, 2025 - June 24, 2025

Departure Time: 8:30AM on 6/20 from Walmart on Iowa St. (3300 Iowa St, Lawrence, KS 66046)

COST: $675, a deposit of $200 is required to hold your spot.

Deposit is nonrefundable after April 1, 2025.

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Contact Tim Caseria at [email protected] or (630) 917-1198.

Participant Information

Guest Type

Summer 2025

Clearwater Cove Week 5

Registration Options

Register with a deposit or full payment ($675.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with offline payment or no deposit ($675.00)

Participant Name

Date of Birth

Participant Phone

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Participant Email

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Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

High School Graduation Year

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant

Address

Would you like to cover the 2.5% credit card processing fee?

Total

$0.00

Coupon Code

Participant Information

Parent / Guardian Information

Billing Information