Request Brochure, DVD and Information

The KenMont and KenWood Office will be closed for vacation starting
Monday, September 6th and will re-open in Miami on Monday, September 13th.
We will process your request for information upon our return.

Please provide the following information. ( * denotes a required field )
You must enter information for at least one parent.

2011 Camp Dates

1st Session: Wednesday, June 29 - Sunday, July 24

2nd Session: Wednesday, July 27 - Sunday, August 21

Year Interested In*
Session Interested In*

	Parent 1		Parent 2
Relationship*		Relationship
Title*		Title
First Name*		First Name
Last Name*		Last Name
Home Phone*		Home Phone
Work Phone		Work Phone
Cell Phone		Cell Phone
E-mail*		E-mail

Mailing and Contact Information
Send Mailing to (Name)*
Address*
City*
State*
Zip*
Country

Potential Camper Information (please complete for each child)
	1st Camper		2nd Camper
First Name*		First Name
Last Name*		Last Name
Gender*	Male Female	Gender	Male Female
Grade entering Sept. 2010*		Grade entering Sept. 2010
School*		School
Previous Camping Experience*		Previous Camping Experience

	3rd Camper		4th Camper
First Name		First Name
Last Name		Last Name
Gender	Male Female	Gender	Male Female
Grade entering Sept. 2010		Grade entering Sept. 2010
School		School
Previous Camping Experience		Previous Camping Experience

How did you hear about us?
Friend Referral Agent Website Other Please Specify Name*

Please let us know your child's interests and any special notes you would like to share with our Directors


This Request was filled out by*