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Tell us more about yourself and your needs. We will get back to you with some specific suggestions:
Name of Student
First Name:
Last Name:
Sex:
M
F
Grade (04-05 School Year):
Age:
Date of Birth:
MM/DD/YYYY
First Time Camper?
Yes
No
If no, previous summer experience:
Parent or Guardian
*First Name
*Last Name
Relationship to Student:
Self
Mother
Father
Other
*Day Phone Number:
Area Code 7 Digit Phone Number
*Evening Phone Number:
Area Code 7 Digit Phone Number
E-mail Address:
Street Address:
City:
State:
Zip:
Special Needs:
I am interested in:
Traditional Sleep Away Camps:
Check as many as apply
Co-ed
Brother/Sister
Single Sex
Number of weeks (2-8)
Specialty Programs:
Check as many as apply
Teen Tours
USA
Abroad
College Programs
Academics
Enrichment
Remedial
Adventure/Wilderness
Art
Dance
Sailing/Scuba
Drama/Theater
Film/Photography
Music
Voice
Instrument
Weight Loss
Community Service
Computers
Marine Biology
Other
Language:
Check as many as apply
Spanish
French
Other
Study in USA
Study Abroad
Sports:
Check as many as apply
Baseball
Basketball
Biking
Golf
Gymnastics
Hockey
Horseback Riding
Lacrosse
Roller Blading
Skiing
Soccer
Tennis
Volleyball
Additional Children:
Name of Student #2:
First Name:
Last Name:
Sex:
M
F
Grade (02-03 School Year):
Age:
Date of Birth:
MM/DD/YYYY
First Time Camper?
Yes
No
If no, previous summer experience:
Type of Program:
Name of Student #3:
First Name:
Last Name:
Sex:
M
F
Grade (02-03 School Year):
Age:
Date of Birth:
MM/DD/YYYY
First Time Camper?
Yes
No
If no, previous summer experience:
Type of Program:
*Fields that must be completed before submitting the form.
Call now
(973) 992-8198 or (888) 873-6363
Student Summers
sm
and The Camp Lady
®
are registered service marks
of Student Summers, Inc.