BROCHURE REQUEST
First Parent/Guardian Information   Second Parent/Guardian Information
Title:
*First Name:
*Last Name:
*Relationship to child(ren):
*Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
*Home Phone:
Work Phone:
Cell/Mobile Phone:
*Email:
 
Title:
First Name:
Last Name:
Relationship to child(ren):
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Home Phone:
Work Phone:
Cell/Mobile Phone:
Email:
 
*We are exploring camp for the summer of:
 
First Child's Information
*First Name: *Last Name:
*Current Age: *Current Grade:
*Date of Birth: *Gender: Male   Female
School:
Previous Camp Experience:
 Interests:
 
Second Child's Information
First Name: Last Name:
Current Age: Current Grade:
Date of Birth: Gender: Male   Female
School:
Previous Camp Experience:
 Interests:
 
Third Child's Information
First Name: Last Name:
Current Age: Current Grade:
Date of Birth: Gender: Male   Female
School:
Previous Camp Experience:
 Interests:
 
*How did you hear about Camp Modin?
Referral Service    Website/Search Engine    Camp Family    Other

 
Additional Comments


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.

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