Parent/Guardian #1 Information (Primary Contact)
* First Name 
* Home Phone 
XXX-XXX-XXXX 
* Last Name 
  Work Phone 
XXX-XXX-XXXX 
* Address 
  Extension 
* City 
  Cell Phone 
XXX-XXX-XXXX 
* State 
* Email 
* Zip 
  Occupation 
  Country (if not US) 


Parent/Guardian #2 Information
  First Name   Home Phone 
XXX-XXX-XXXX 
  Last Name   Work Phone 
XXX-XXX-XXXX 
  Address   Extension 
  City   Cell Phone 
XXX-XXX-XXXX 
  State   Email 
  Zip   Occupation 
  Country (if not US) 
  Who receives emails? 


Custody
* Camper lives with 
  Please explain custody
if applicable 


Additional Information
  May we donate your daughter's spending allowance refund to the Netimus Tuition Assistance Program? 
  May we use your name and contact information as a reference for prospective campers? 


In case of emergency, if the Director is unable to reach the family, call
* First Name 
* Last Name 
  Relationship * Home Phone 
XXX-XXX-XXXX 
  Cell Phone 
XXX-XXX-XXXX 
  Address   City 
  State   Zip 


Please list below the names and addresses of parents who might
be interested in receiving information about Camp Netimus
  Parents   Camper/Age 
  Address   City, State, Zip, Country 


Registered Campers
You have not registered a camper at this time.



Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.

Contact Us: Camp Netimus Camp for Girls •• 708 Raymondskill Rd., Milford, PA 18337 •• 866-NETIMUS •• info@netimus.com

©2018 SofterWare, Inc. v.2018.01.02-A