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Interested in finding the right camp for your child? Give us a call today at 800.729.7090. Or, complete this form and your information will be e-mailed to us. Once we receive your information, we will follow up by phone or e-mail. Please complete one form per child.

Parent Info:
Title:
First Name:
Last Name:
Name of Person Filling Out Form:
Relationship to Camper:	If 'other', please specify:

Mailing Address:
Street:
City:
State/Province
Postal Code:
Country:


Contact Preferences:
Daytime Phone:	E-Mail Address:
Evening Phone:
Preferred Contact Method:	Phone	Email
Preferred Time (Phone Only)	Morning	Evening

Camper Information:
Camper's First Name:
Camper's Last Name:
Date of Birth:
Current Grade:
Gender:	Male	Female
1st Time Camper?	Yes	No
Previous Programs Attended (Separate by Commas):
Length of Desired Program Session:

General Program Questions:
Program Type:
Desired Location(s):	Northeast	Mid-Atlantic	Southeast
	Midwest	Outside USA	Flexible
Is there a Specific Location?
Special Interests:
Special Needs:

Specialty Program Questions
Specialty Camps:	Fine Arts	Performing Arts	Music
	Weight Control	Academic	Teen Travel
	Wilderness / Adventure		Community Service
	Sports	Specify
	Language	Specify
	Religious	Specify
	Special Needs	Specify
	Other	Specify

Other Information:
How Did You Find Us?	If 'other', please specify:


Please provide us with any other important information or comments.