Pre-Registration Form

      
            *Please note: If you are having problems with this form, please try the form again in a different Internet Browser. For example, if you are using Internet Explorer, please try again using Firefox, Chrome, or Safari.*
Parent Information
Name(s)*
			  									
					 			  
				
			  			  
				  
Address:
              Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code
Phone:*              
                                                
                  Area Code
                
                                  -
                
                                  
                  Phone Number
                
              
              
E-mail:
Child Information
Name:*
              										  
					  First
					
					
										  
					  Last
					
					
Gender:
Male
Female
Other
Prefer not to say
Birthdate:
 / 
 / 
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?
 Follow the directions to confirm you are a real person:
*Please note: If you are having problems with this form, please try the form again in a different Internet Browser. For example, if you are using Internet Explorer, please try again using Firefox, Chrome, or Safari.*

Please note: If you are having problems with this form, please try the form again in a different Internet Browser. For example, if you are using Internet Explorer, please try again using Firefox, Chrome, or Safari.

Parent Information

Child Information

Presenting Concerns

Please note: If you are having problems with this form, please try the form again in a different Internet Browser. For example, if you are using Internet Explorer, please try again using Firefox, Chrome, or Safari.

Latest Information

Pre-Register for Camp Attaway

Attaway Calendar of Events