Chinmaya Mission Peoria - Summer Camp Registration
Venue: Chinmaya Mission Peoria, 8001 N. University, 2nd Floor, Peoria, IL 61615 | Rohinikumar Adivi 309.243.1282
Date and Time: June 21 - 23; 8:30 a.m. - 4:30 p.m.
Camp Fee: $125 per child
Parent Information
First Name *
Last Name *
Please enter first name.
Please enter last name.
Phone Number (numbers only)*
Email Address *
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Please enter phone number properly.
Please enter email address.
Street Address Line 1 *
Street Address Line 2
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City *
State *
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ZIP Code *
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Please enter proper ZIP code.
Additional Contact
Additional Contact Name
Additional Phone Number (numbers only)
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Additional Email Address
Children Information
Name of Child 1
Child's Grade (Fall 2019)
Please provide child's name.
Pre-K
Kindergarten
1
2
3
4
5
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7
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9
10
11
12
Please select child's grade.
Name of Child 2
Child's Grade (Fall 2019)
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Name of Child 3
Child's Grade (Fall 2019)
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Name of Child 4
Child's Grade (Fall 2019)
Pre-K
Kindergarten
1
2
3
4
5
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7
8
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11
12
Additional Notes:
Additional donation amount ($):
Total Fee/Donation Amount :
0
Please select payment method.
Payment Method:
Check
PayPal/Credit Card
If you are paying through PayPal/Credit Card, clicking the Register button will take you to the PayPal site for payment.
If you are paying through check, please make checks
payable to Chinmaya Mission Peoria
and mail check to the following address.
Mailing Address:
Chinmaya Mission Peoria
8001 N. University, 2nd Floor
Peoria, IL 61615
If the Register button is not responding, there could be errors on the top of the page. Please correct and submit again.