Family Camp (October 19-22, 2023) - Fort Rock Family Camp

Family Information

Head of Household Name*

First Last

Spouse's Name

First Last

Additional Family Members

Name	Age	Gender

Add additional family members using the checkbox on the right.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Secondary Phone

Email*

Additional Information

Message/Comments

Please feel free to send any comments or questions along with this registration.

Event Information

Event Options*

($350 base fee)

Private Cabin – (0 spots left)

Adults*

$110 per adult

Select the number of adults (individuals 13 years of age or older) attending.

Please enter a number greater than or equal to 1.

Children*

$75 per child

Select the number of children (individuals between the ages of 5 and 12 years old) attending.

Please enter a number greater than or equal to 0.

Infant/Toddler*

FREE

Select the number of infants/toddlers (4 years of age or younger) attending.

Please enter a number greater than or equal to 0.

Billing & Payment

Payment Options*

Register and pay in full
Register and reserve spot ($150 deposit)

Subtotal

Sales & Tourism Tax

Arkansas State Sales and Tourism Tax (10.5%)

TOTAL

Payment Amount

Price: $0.00

Payment Amount

Price:

BALANCE DUE

$0.00

DEPOSIT

$0.00

Coupon Code

REMAINING BALANCE

The remaining balance represents the total amount minus your $150.00 deposit. The remaining balance is due in full 3 weeks prior to your event date.

Credit Card*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Acknowledgement*

Yes, I acknowledge I have read the cost and payment terms, cancellation policy, and privacy policy and by submitting this registration I agree to the terms and conditions of use.

A confirmation packet will be emailed within two weeks. Specific instructions for check-in and check-out, what to bring, and directions to camp will be included.

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Camp Registration