MYSTIC QUARRY CAMPOUT – TX C.U.R.E., Inc

Mystic Quarry Campout Event Registration (#7)

Mystic Quarry Campout

Please register for this event below.

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Zip Code

Please let us know the name of the Inmate the child is related.

First Name

Last Name

TDCJ #

How many children will be attending? If more than 4, Please indicate in the comment section below.

Is the Child/Children Attending between the ages of 7 to 17?

YES

Age of each Child attending? You can select the age of each child.

Child Relationship to inmate

Relationship to Inmate's attending Child/Children

Parent

Custodian/Guardian

Any special accommodations or special needs required:

Comments (optional)

I Understand that I will be required to sign a Release form at the time of the Event or before.