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Home
About Us
Menu Toggle
Founder & History
Board of Directors
Executive Director
Attaway Staff
Job Opportunities
Attaway Newsletter
Our Programs
Menu Toggle
Club Attaway
Year-Round Parent Groups
Camp Attaway
Menu Toggle
Pre-Register
Activities
Therapeutic Components
Counselors In Training
Impact
Make Payment
Events
Help Camp Grow
Menu Toggle
Financial Partners
Amazon/United Way
Donations
Other Ways to Help
Contact Us
Donate
Main Menu
Home
About Us
Menu Toggle
Founder & History
Board of Directors
Executive Director
Attaway Staff
Job Opportunities
Attaway Newsletter
Our Programs
Menu Toggle
Club Attaway
Year-Round Parent Groups
Camp Attaway
Menu Toggle
Pre-Register
Activities
Therapeutic Components
Counselors In Training
Impact
Make Payment
Events
Help Camp Grow
Menu Toggle
Financial Partners
Amazon/United Way
Donations
Other Ways to Help
Contact Us
Donate
Home
About Us
Menu Toggle
Founder & History
Board of Directors
Executive Director
Attaway Staff
Job Opportunities
Attaway Newsletter
Our Programs
Menu Toggle
Club Attaway
Year-Round Parent Groups
Camp Attaway
Menu Toggle
Pre-Register
Activities
Therapeutic Components
Counselors In Training
Impact
Make Payment
Events
Help Camp Grow
Menu Toggle
Financial Partners
Amazon/United Way
Donations
Other Ways to Help
Contact Us
Donate
Home
About Us
Menu Toggle
Founder & History
Board of Directors
Executive Director
Attaway Staff
Job Opportunities
Attaway Newsletter
Our Programs
Menu Toggle
Club Attaway
Year-Round Parent Groups
Camp Attaway
Menu Toggle
Pre-Register
Activities
Therapeutic Components
Counselors In Training
Impact
Make Payment
Events
Help Camp Grow
Menu Toggle
Financial Partners
Amazon/United Way
Donations
Other Ways to Help
Contact Us
Donate
Main Menu
Home
About Us
Menu Toggle
Founder & History
Board of Directors
Executive Director
Attaway Staff
Job Opportunities
Attaway Newsletter
Our Programs
Menu Toggle
Club Attaway
Year-Round Parent Groups
Camp Attaway
Menu Toggle
Pre-Register
Activities
Therapeutic Components
Counselors In Training
Impact
Make Payment
Events
Help Camp Grow
Menu Toggle
Financial Partners
Amazon/United Way
Donations
Other Ways to Help
Contact Us
Donate
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
Birthdate:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
day
/
January
February
March
April
May
June
July
August
September
October
November
December
month
/
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
year
Grade:
Select Grade
K - Kindergarten
1 - First Grade
2 - Second Grade
3 - Third Grade
4 - Fourth Grade
5 - Fifth Grade
6 - Sixth Grade
7 - Seventh Grade
8 - Eighth Grade
9 - Ninth Grade
10 - Tenth Grade
11 - Eleventh Grade
12 - Twelfth Grade
Name of school attending and how did you find out about Camp Attaway?
Presenting Concerns
Please describe or explain briefly.
Attention Issues:
*
Social Issues:
*
Compliance Issues:
*
Self-Regulation Issues:
*
History of Summer Camp Experience:
Follow the directions to confirm you are a real person:
Submit
Reset
*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.*
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