Registration now CLOSED!

General Butler State Resort Park - 1608 Kentucky 227, Carrollton, KY
June 23, 2014 - 10 a.m. - June 24, 2014 - 3:30 p.m. (registration begins at 8:30 a.m. on 6-23-2013)

PARTCIPANTS MUST BE ENROLLED IN GRADES 8-12 IN 2014-2015 SCHOOL YEAR

$75.00 Per Person (minimum group consists of 4 youth participants & 1 adult sponsor)

Submit any questions to amy.andrews@ky.gov

* 1. School/Organization Name

* 2. Registration fee of $75.00 per person (minimum of 4 youth participants & 1 adult sponsor required for successful registration)
Check or Purchase Order # - (checks / P.O. payable to Kentucky Crime Prevention Coalition - and mailed to
Amy Andrews, 125 Holmes Street, Frankfort, KY 40601 - Purchase Orders can be faxed to 502-564-6104)

* 3. Adult Sponsor Name, Address. E-mail Address, Daytime Phone, Evening Phone, T-shirt size

* 4. Youth Participant 1 Name, Grade,Gender, T-shirt Size

* 5. Youth Participant 2 Name, Grade, Gender, T-shirt Size

* 6. Youth Participant 3 Name, Grade, Gender, T-shirt Size

* 7. Youth Participant 4 Name, Grade, Gender, T-shirt Size

* 8. any dietary or disability requirements?

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