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attawayprograms@gmail.com

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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 Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Phone:*

Area Code

-

Phone Number

E-mail:

Child Information

Name:*

First

Last

Gender:

Male

Female

Other

Prefer not to say

Child's Date of Birth:

day

/

month

/

year

Grade:

Name of school attending?

Presenting Concerns

Please describe or explain briefly.

Attention Issues:*

Social Issues:*

Compliance Issues:*

Self-Regulation Issues:*

History of Summer Camp Experience AND 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.

9770 Patuxent Woods Dr.

Suite #303

Columbia, MD 21046

Main Line: 443-518-7671

Fax: 443-518-7672

attawayprograms@gmail.com

2021 Camp Attaway

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