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CONTACT
Tell us more about yourself and your needs. We will get back to you with specific suggestions:
Name of Student
First Name
Last Name
Male Female
Age
*Grade
Date of Birth MM/DD/YYYY
First Time Camper? Yes No
If no, previous summer experience
Additional Children (Name of Student #2)
First Name
Last Name
Male Female
Age
*Grade
Date of Birth MM/DD/YYYY
First Time Camper? Yes No
If no, previous summer experience
Additional Children (Name of Student #3)
First Name
Last Name
Male Female
Age
*Grade
Date of Birth MM/DD/YYYY
First Time Camper? Yes No
If no, previous summer experience
Name of Parent or Guardian
*First Name
*Last Name
Relationship to Student Self Mother Father Other
*Day/Phone Number
*Evening/Phone Number
E-mail Address
Street Address
City
State
Zip
Type of camp/teen program

Day Camp Sleep Away Camp Teen Summer
Specialty Programs:

Teen Tours Academics/Enrichment
Adventure/Wilderness Art
Dance Music Weight Loss
Community Service Computers
Sailing/Scuba Sports
Special Interests
Language:
Spanish French
Other
Study in USA Study Abroad
*Fields that must be completed before submitting this form
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