2026 Camp Pennbrook Registration

2026 Camp Registration Form

You can register for camp here by filling out the form below and select the dates of your choice or by calling us at 800-442-7366 (or 212-354-2267). The minimum stay is two weeks, and can start as early as June 20th. If you require different dates, please call and we will do our best to accommodate you.
Camper's Information
Camper Name
Date of Birth

MonthDayYear
Age
Entering Grade in September
Primary Email
example@example.com
Camper's Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Camper Attends
How Did You Learn About Camp Pennbrook?
If Referral Agency or Friend/Relative please list here:

Parents' Information

Parent/Guardian 1
Parent/Guardian 1

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name
Or enter N/A if not applicable
Parent's Work Phone
Format: (000) 000-0000.
Parent's Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents' Information

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address Same as Parent/Guardian 1?
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name
Or enter N/A if not applicable
Parent's Work Phone
Format: (000) 000-0000.
Parent's Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Medical / Health Information
Major Medical Carrier
Policy Number