First Name:
Last Name:
Spouse/Friend First Name:
Spouse/Friend Last Name:
Street Address:
City
State
Zip Code:
Phone Number:
E-Mail Address:
All meals are included in all price categories
Day Rate - $10.00 per person
Requesting an Individual Scholarship
(*Please note - if checked,
Canterbury's Director of Program will contact you.)

Any special needs? (i.e. diet, physical limitations)

Payment is due upon arrival. 
We accept Cash, Checks, All Major Credit Cards.