Camper and Family Information

Home Address

Hamptons Address*

Hamptons Phone Number*
Parents' Marital Status

MarriedSeparatedDivorced
Mom's Name*

First Name Last Name
Mom's Cell*
Mom's E-mail*
Dad's Name*

First Name Last Name
Dad's Cell*
Dad's E-mail*
Is your child currently attending school?

YesNo
Does your child receive any special services or have an IEP?
Does your child have any food allergies or medical issues we should be aware of? Please Describe
Is there any information regarding your child that you feel our camp should be aware of so that we can better care for him/her?
In one line, how would you describe your child?
Sibling(s)' name(s) and age(s)
I would like to receive news and updates by email
Should be Empty:

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