Parent's First Name:
Parent's Last Name:
Mailing Address:
Street:
State:
Town:
Zip:
Country:
E-Mail:
Home Phone:
Work Phone:
Camper's First Name:
Camper's Last Name:
Camper's Age:
Camper's School Grade:
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 select the session you desire.
How did you learn about Camp Lohikan: (Please check all sources that apply.)
Search Engine?
Website Directory?
Other Source?
If you found about Lohikan through a friend, please indicate his or her name:
Person completing this form:
If "other" please explain: