Lake Greeley Camp - Information Request Form

Please fill out the following sections, at least, when completing the form: First Name, Last Name, Street, City, State, and Zip in the Parent's Information Section. When completing this form for information, please consider our camper enrollment are for grades between 1st and 10th grade. Also, please make sure to fill in the validation question at the bottom of the form. When you have completed and submitted the form, you will be redirected to a confirmation page.

PARENT'S INFORMATION
*First Name:**		*Last Name:**

Mailing Address:		Contact Information:
*Address:**		Parent's Email:
Address (Line 2):
*City:**		Home Phone:
*State:**		Work Phone:
*Zip:**		Cell Phone:
Country:

CAMPER'S INFORMATION

First Name:		Last Name:
Date of Birth:		Grade:
Gender (M/F):
If there is more than one child interested in camp, please indicate their name, age and school grade:

Has your child attended day camp?	Has your child attended overnight camp?
Please indicate the session you desire:

SOURCE INFORMATION

How did you learn about Lake Greeley Camp:
Search Engine?		Website Directory?
Other Source?		If "other or friend" please explain:

Person completing this form:		If "other" please explain:

We thank you for your interest!

Validation Question*:What is 2+2?