Breakaway 2018
May 27 - June 1, 2018
Camp Table Rock
Shell Knob, MO

This is the registration for Breakaway Youth Camp. This registration plus a $100 deposit will reserve your spot on the bus. You can pay online or on the 4th floor.
Cost: $400 Two siblings $655 Three siblings $955

**Early Bird Registration thru April 15, 2018 $380 - Full payment or $100 deposit must be made by April 15th to get Early bird rate.

Email address *
Students First Name *
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Students Last Name *
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Gender *
Grade for 2017-18 school year *
Address *
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Shirt Size *
Guest Of:
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Zip *
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Parent Email *
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Emergency Contact *
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Emergency Contact Cell Number *
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Paying Online or on the 4th floor *
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