Edmond Historical Society

Edmond Historical Society > Wine Through Time Tickets & Sponsorships

Parent Name*
First Last
Parent Phone*
Parent Email*
Emergency contact person (other than parent listed above)*
First Last
Emergency contact phone number*
Child(ren) you are registering*
To add additional children, click the plus sign to add another row.
Child Name Birthday (Month/Year) Gender Has this child attended our summer camp before? Any allergies?
Camp Registration*
Enter the number of children you are registering in the "Quantity" box.
Price: $50.00
Total
$0.00
Be sure you are registering for the session you want--this form is for Session 4, which is June 28, 29 & 30.
Payment method*
Please select whether you'd like to pay securely online, or mail a check.
- Pay online by credit card
- Mail a check
When you click "submit," you'll be redirected to the secure payment form. Fill out this form with your credit card information to make your payment online!

Child Name	Birthday (Month/Year)	Gender	Has this child attended our summer camp before?	Any allergies?