Cretin-Derham Hall :: Senior Lock-In Online Registration

Parent/Guardian 1 Name*

First NameLast Name

Parent/Guardian 2 Name

First NameLast Name

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Email Address*

example@example.com

Parent/Guardian Phone Number*

Area CodePhone Number

Senior 1 Name*

First NameLast Name

Senior 2 Name

First NameLast Name

Senior 3 Name

First NameLast Name

If you have more than one Senior attending the Senior Lock-In, please make sure you select the appropriate number in the dropdown of the "Registration" section. The cost is $105.00 per senior. Optional donations are appreciated to offset party expenses above and beyond the fee per student. Thank you.

Registration*

2025 Senior Lock-In per Student$105.00

Select Quantity

2025 Lock In $10.00 donation$10.00

2025 Lock In $20.00 donation$20.00

2025 Lock In $50.00 donation$50.00

2025 Lock In $100.00 donation$100.00

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Email

example@example.com

Raffle Prize Donation to 2025 Senior Lock-In

Additional Information

Enter the message as it's shown*