Camp Modin - Request Brochure

Thank You

Your brochure request has been successfully submitted. You should receive it in the mail within a week. If for any reason you do not, please call our offices or send an email to modin@modin.com. We look forward to speaking with you and becoming acquainted with your family.

With warmest regards,

The Modin Team

Brochure Request

* required field

First Parent/Guardian Information

Role / Relationship to child(ren):

Title:

* First Name:

* Last Name:

* Email:

* Home Phone:

Cell/Mobile Phone:

Second Parent/Guardian Information

Role / Relationship to child(ren):

Title:

First Name:

Last Name:

Email:

Home Phone (only if different):

Cell/Mobile Phone:

* We are exploring camp for the summer of:

Home Address

* Country:

* Address:

* City:

* State/Province:

* Zip/Postal Code:

First Child's Information

* First Name:

* Last Name:

* Date of Birth:

* Current Age:

Previous camp experience:

Current school:

* Current grade:

* Gender:

Male Female

Interests:

Second Child's Information

First Name:

Last Name:

Date of Birth:

Current Age:

Previous camp experience:

Current school:

Current grade:

Gender:

Male Female

Interests:

Third Child's Information

First Name:

Last Name:

Date of Birth:

Current Age:

Previous camp experience:

Current school:

Current grade:

Gender:

Male Female

Interests:

Final Questions

How did you hear about Camp Modin?

Please specify:

Additional comments:

Website:

Children's privacy is of primary concern to us, and our Policy and practices reflect applicable laws and regulations on children's privacy. We do not knowingly collect personal information from children under 18 years of age. Any communication we get that is identified as being from a child under 18 will be immediately removed from our database. All information gathered from our camp families is used exclusively for camp, and no third-party vendors. We urge parents to regularly monitor and supervise their children's on-line activities.