NATIONAL CAMP ASSOCIATION INSTRUCTION/FACT SHEET As you complete your questionnaire, please refer to this fact sheet. This will provide us with the most accurate information on your child. Please fill out a separate questionnaire for each child or friend that is interested in attending a sleepaway program. DOB: Your child's date of birth. OTHER: To be filled out by person other than a parent filling out the questionnaire. SIBLINGS: List any brothers or sisters including age. FRIENDS/RELATIVES: List any other children that might attend with your child. TYPE OF CAMP: CO-ED:shared recreational and dining facilities, separate living quarters, interaction varies. BROTHER/SISTER: physically separate but related camps, one for boys,one for girls, interaction varies. STRUCTURE: Based on an eight period day 1) Traditional: 6-7 prescheduled periods, 1-2 free choice periods 2) Semi-elective: 3-4 prescheduled periods, 3-4 free choice periods 3) Elective: 6-8 free choice periods, 0-2 prescheduled periods * Participation in all activities is required and supervised. COST: Because the cost of camp varies greatly, it is important to determine the maximum amount you are willing to spend. The variation in cost is often a reflection of program offerings. - Camp Costs - Full Season (7-9 Weeks) $5500 - $13000 Monthly $2500 - $7000 Weekly $500 - $2000 By providing an accurate and realistic response to the question of cost, you will insure that we include the most appropriate recommendations. If cost is not a factor, please enter "Open". RELIGION: Please indicate your religious preference, if any, and if services are required. LOCATION: Please let us know what regions and/or states you prefer. You may select any combination of regions and/or states. Flexibility is important, as a narrow selection may limit choices and exclude the best one. *IMPORTANT*- If you are uncertain how to fill out the questionnaire form, please follow these instructions. To respond by email: 1)Highlight the questionnaire by "dragging" the arrow over the entire form. 2)Click on REPLY, fill in your responses and send to info@summercamp.org. To fax back: 1)Click the Print button on your browser. 2)Fill out the form and fax it to 763-219-8468. If you wish to speak with a camp advisor, please call 1-800-966-2267 or 212- 654-0653 9:30am-5pm, EST, Monday through Friday. PLEASE SCROLL DOWN TO QUESTIONNAIRE BELOW CODE I: 1 2 3 4 RETURN VIA FAX TO: 763-219-8468 II: ____________________________________________ III: _______ IV:___________ ************************* Above Section For Office Use Only ********************* QUESTIONNAIRE -Summer 2010 [ ] 2011 [ ] 2012 [ ] How did you hear about us? ___________________________ Today's Date: ___/___/___ Child 1:_____________________________ DOB:___/___/___ Sex:___ Age:____ Gd:____ Child 2:_____________________________ DOB:___/___/___ Sex:___ Age:____ Gd:____ Parent(s): ______________________________________ Other: ________________________ Street Address: _________________________________________________________________ City/Town: _________________________ State: _______ Zip/Postal Code: ___________ Country (if not US): _________________________ EMail: ___________________________ Home Phone:( )_____________ Work Phone:( )____________ Cell Phone:( )_____________ Fax:( )_____________ Siblings: _________________________________________________ Ages: ______________ Friends/relatives that may attend camp:__________________________________________ TYPE OF CAMP STRUCTURE Length (weeks): _______ Jun[ ] Jul[ ] Aug[ ] Coed [ ] Traditional [ ] Bro/Sis [ ] Semi-elective [ ] Location: ___________________________________ Boys [ ] Elective [ ] Girls [ ] Maximum Cost($): ____________________________ Previous sleepaway camp exp? Y[ ] N[ ] Camp(s): _________________________________ COMPETITION HEALTH/PHYSICAL DIETARY Yes [ ] Impairments: Y [ ] N [ ] Kosher [ ] Religion: ____________ No [ ] Vegetarian [ ] Some [ ] Specify: _________________ Food Allerg [ ] Services: Y[ ] N[ ] Fluent In English? Y [ ] N [ ] Some [ ] English Instruction Y [ ] N [ ] PROGRAM/ACTIVITY INTERESTS Child 1: ________________________________________________________________________ Child 2: ________________________________________________________________________ Additional Concerns: ____________________________________________________________ Camps you have already contacted: _______________________________________________ ******************************* For Office Use Only ***************************** RECOMMENDATIONS: TOLD PARENT TOLD CAMP FAXED CAMP SENT CAMP ______ ______ ______ ______ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ______ ______ ______ ______ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ______ ______ ______ ______ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ CAMP: SEND - VIDEO[ ] CD[ ] DVD[ ] OFFICE SEND VIA: EMAIL[ ] FAX[ ] MAIL[ ]