Youth Group Kayak Trip

Name *

First

Last

Email *

Phone *

Name of First Child Participating *

Please check if this child has these items to bring for themselves:

Name of Second Child Participating (if applicable)

Please check if this child has these items to bring for themselves:

Name of Third Child Participating (if applicable)

Please check if this child has these items to bring for themselves:

Phone

9501 Folsom Boulevard, Sacramento, CA 95827
Mailing Address:
PO Box 660425, Sacramento, CA 95866

916-920-2900

fatherhezekias@gmail.com

How much would you like to donate?

$10 $20 $30

Would you like to make regular donations? I would like to make donation(s)

How many times would you like this to recur? (including this payment) *

Name *

Last Name *

Email *

Phone

Address

Additional Note

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