Director's name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of camp (check all that apply) *

CITY/TOWN/VILLAGE

EDUCATIONAL/ENRICHMENT

OVERNIGHT

SPECIAL NEEDS

SPORTS

TRADITIONAL

DAY CARE CENTER (ONLY IF PROGRAM IS RUN OFF-SITE)

Camp start date *

MM

DD

YYYY

Camp end date *

MM

DD

YYYY

Extended hours? *

Yes

No

Financial aid available? *

Yes

No

Transportation provided? *

Yes

No