Spring Lake Day Camp Request Form
Serving Bergen, Passaic, Morris and Essex Counties.
In accordance with the Children's Online Privacy Protection Act
a person must be 13 years of age or older to complete and submit this form.

Please Fill Out & Complete All Fields

Request
Information For:

Full Session (8 weeks)
Any 7 Weeks
Any 6 Weeks
Any 5 Weeks
First 4 Weeks
Second 4 Weeks
Leadership Training Program
(entering 10th grade)
Mini Day Program (3 and 4 year olds only)

An informational DVD and application
will be mailed along with promotional information.

Schedule A Tour:

Open House Fall Fest, Sunday, October 17th

Or enter your own desired date(s):

Or please call to schedule a private tour Monday-Friday.

First Name:
Last Name:
Address Line 1:
Address Line 2:
City: State:
Zip: Country:

Home Phone #:
Work Phone #:
Email Address: REQUIRED

Child's NameDate of BirthGrade as of
Sept. 2010

Additional Comments or Information:
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