CampSource Network - Request Camp Info

Please complete the form below and a CampSource representative will contact you.
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Form completed by:

How did you here about us?

Referred By:

Parents’ Information:

Mother’s Full Name:

Father’s Full Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Parent Email Address:

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Child’s Information:

Child’s Name:

Date of Birth:

Current Age:

Current School Grade:

Gender:

FemaleMale *

Additional Siblings:

Sibling 1 Name:

Sibling 1 Birthday:

Sibling 2 Name:

Sibling 2 Birthday:

Program Information:

Previous Summer Experience:

1st Overnight Experience:

Length of Stay:

Type of Camp: (Check all interests)

Child’s Personality

Competitive	Outgoing
Non-Competitive	Shy

Childs Interests :
(Check all interests)

Sports:

Outdoor Adventure:

Arts:

Size of Camp:

Camp Location:

Religious Affiliation

Desired price range per week:

Is your child planning to attend a summer program with a friend? If yes:
Friend's Name:
Friend's Phone Number:

Medical Info: Does your child have any medical conditions(s) that we should be discussing with the director?


Any Special Needs?

Anything else about your child that will help us fill their needs: