Pre-Registration Form

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      Parent Information
Name(s): 
Address: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code
Phone: - 
Area Code Phone Number
E-mail: 

Child's Information
Name: 
First Last
Gender: Male Female
Birth Date:  /   /  
day month year
Grade: 

Presenting Concerns
Please describe or explain briefly.
Attention Issues 
Social Issues 
Compliance Issues 
Self-Regulation Issues 
History of summer camp experience
How did you find out about Camp Attaway?
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Parent Information

Child's Information

Presenting Concerns

Latest Information

Pre-Register for Camp Attaway

Attaway Calendar of Events