CampSource Network - Request Camp Info

Please complete the form below and a CampSource representative will call you. Remember to indicate the best time to call.
* = Required Field

Form completed by:

Child will be attending summer of:

How did you hear about us?

Name of person who referred you:

Which CampSource consultant
were you referred to?

Parents’ Information:

Parent 1 Full Name:

Parent 2 Full Name:

Address:

City:

State:

Postal Code:

Country:

Daytime Phone:

Evening Phone:

Best Time and Number to Call:

Parent Email Address:

Child’s Information:

Child’s Name:

Date of Birth:

Current Age:

Current School Grade:

Name of School:

Gender:

FemaleMale *

Additional Siblings:

Sibling 1 Name:

Sibling 1 Birthday:

Sibling 2 Name:

Sibling 2 Birthday:

Child’s Personality

Competitive	Outgoing
Non-Competitive	Shy

Child's Interests (check all that apply):

Other Interests:

1st Overnight Experience?

Previous Summer Experience:

Camp Information:

Type of Camp Desired: (Check all that apply)

Other type of camp:

Location Preference:

Desired budget per week:

Length of Stay:

Size of Camp:

Religious Affiliation:

More Information:

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

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:


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