Thank you for your interest in Champion Day Camp for the summer of 2012.

Camp starts June 25th, 2012. It's time To Be A Champion!!!

Please Fill Out ALL Fields!!!

* Would you prefer to receive our brochure via

Email

US Postal Mail?

Parent Information

* Relationship to Future Camper:

Mother

Father

Other

* First Name

* Last Name

* Address

* City

* State

* Zip

* Home Phone

Cell Phone

Work Phone

Email Address

Please verify email address

Future Camper(s)' Information

* First Name

* Last Name

* Date of Birth:

* Grade Sept '12:

* Gender

First Name

Last Name

Date of Birth:

Grade Sept '12:

Gender

First Name

Last Name

Date of Birth:

Grade Sept '12:

Gender

Additional Comments and/or Questions:

* Has your child or children ever been to camp before?

Yes

No

* How did you find out about Champion Day Camp?

* Indicates Response Required