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Please fill out the following sections, at least, when completing the form: First Name, Last Name, Street, City, State, and Zip in the Parent's Information Section. When completing this form for information, please consider our camper enrollment are for grades between 1st and 10th grade. Also, please make sure to fill in the validation question at the bottom of the form. When you have completed and submitted this form, you will be redirected to a confirmation page.


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PARENT'S INFORMATION

First Name*:

/home2/lakegre2/public_html/inforequest.php on line 137
" size="25" tabindex="1">

Last Name*:

/home2/lakegre2/public_html/inforequest.php on line 139
"size="25" tabindex="2">

Mailing Address:

Contact Information:

Address*: 

/home2/lakegre2/public_html/inforequest.php on line 152
"size="25" tabindex="3" title="Street address, P.O. box, company name, c/o">

Parent's Email:

/home2/lakegre2/public_html/inforequest.php on line 156
"size="25" tabindex="8" title="Your email is the primary method we will be using to contact you. If you prefer phone calls, you can add 'Prefer' to your number in that field.">

Address (Line 2):

/home2/lakegre2/public_html/inforequest.php on line 162
"size="25" tabindex="3" title="Apartment, suite, unit, building, floor, etc.">

City*:

/home2/lakegre2/public_html/inforequest.php on line 168
"size="25" tabindex="4">

Home Phone:

/home2/lakegre2/public_html/inforequest.php on line 172
"size="25" maxlength="13" tabindex="9" title="Please enter as XXX-XXX-XXXX (IF from USA)">

State*:

Work Phone:

/home2/lakegre2/public_html/inforequest.php on line 236
"size="25" maxlength="13" tabindex="10" title="Please enter as XXX-XXX-XXXX (IF from USA)">

Zip*:

/home2/lakegre2/public_html/inforequest.php on line 242
"size="10" tabindex="6">

Cell Phone:

/home2/lakegre2/public_html/inforequest.php on line 246
"size="25" maxlength="13" tabindex="11" title="Please enter as XXX-XXX-XXXX (IF from USA)">

Country:
(Do not fill this field if you already live in USA)

/home2/lakegre2/public_html/inforequest.php on line 252
"size="25" tabindex="7" title="Do not fill this field if you live in the United States.">

 

CAMPER'S INFORMATION

First Name:

/home2/lakegre2/public_html/inforequest.php on line 263
"size="25" >

Last Name:

/home2/lakegre2/public_html/inforequest.php on line 265
"size="25" tabindex="13">

Date of Birth:

/home2/lakegre2/public_html/inforequest.php on line 269
"size="10" tabindex="14" title="Please Format as MM/DD/YYYY">

Grade:

/home2/lakegre2/public_html/inforequest.php on line 271
" size="10" tabindex="15" title="The grade your child will be entering after the summer.">
Gender (M/F): /home2/lakegre2/public_html/inforequest.php on line 275
" size="5">
If there is more than one child interested in camp, please indicate their name, age and school grade:

Has your child attended day camp?

Has your child attended overnight camp?

Please indicate the session you are most interested in:

SOURCE INFORMATION

How did you learn about Lake Greeley Camp:
Search Engine? Website Directory?
Other Source? If "other or friend" please explain: /home2/lakegre2/public_html/inforequest.php on line 374
"size="25">
Person completing this form: If "other" please explain: /home2/lakegre2/public_html/inforequest.php on line 390
" size="25">

We thank you for your interest! 

Validation Question*:What is 2+2? /home2/lakegre2/public_html/inforequest.php on line 395
" name="Validation" size="5">


SUMMER: 222 Greeley Lake Rd, Greeley, PA 18425 p. 570.685.7196
WINTER: P.O. Box 219, Moscow, PA 18444 p. 570.842.3739

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Copyright Lake Greeley Camp 2018 email: info@lakegreeley.com
If you have trouble with this page, please contact us through our email.