Junior Service League of St. AugustineJunior Service League of St. Augustine Gala

Night At The Lightner Museum Registration

All proceeds benefit the Lightner Museum Restoration Project
Please complete the form for each child. Registration is complete once the form is filled out and the fee is paid. There are no refunds for withdrawal or absences.
Fields with an asterisk are required.

The cost of the camp is $45 per child/night and $35 per sibling/night. The cost of the camp includes:
• Dinner: Pizza and drink
• Keepsake flashlight
• T-shirt
• Movie dessert: Popcorn w/toppings
You may mail a check to:
     Junior Service League of St. Augustine
     P.O. Box 244
     St. Augustine, FL 32085
or
     Call Holly at 824-3435 with your credit card information.
Your kids will have a great time!

Child's Name
Age
Birth date
Male/Female

T-shirt Size: (child's)
School
Grade in Fall
Parent(s)/Guardian(s)
Address
City
State
Zip
Phone (home)
Phone (cell)
Phone (cell 2nd)
Email
Emergency Contact
Emergency Phone
Special Dietary Restrictions
Date Requested
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