Connect-2-Camp Registration Form
Complete this form below to apply for the Connect-2-Camp Day Camp hosted at New Canaan UMC, New Canaan, CT from June 26th-June 30th, 2023.
1. Contact Information
The following questions refer to you as the Parent/Guardian.
Your Name (Parent/Guardian)
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (cell phone preffered)
*
Please enter a valid phone number.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2. Camper Information
Please complete the following information about your camper.
Camper Name (Child being registered)
*
First Name
Last Name
Preferred Name (Name the camper goes by)
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Date of Birth (campers must be between 5 and 12 years old)
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Grade Level (The grade the child was enrolled in for the 2022-2023 school year)
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
School
*
Emergency Contact
Please provide the information for an individual who can be contacted in case of an emergency, if you are not available:
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Relationship to Camper
3. Camp Enrollment
Connect-2-Camp is a 5-day day camp program, starting June 26th and ending on June 30th. Day camp is 8am-4pm daily.
Please confirm that you understand the dates and times of the program:
Yes, I understand that the Day Camp program runs Monday, June 26th through Friday, June 30th, 8am-4pm. My child will attend daily.
4. Authorized Adults
Please list any adults that are authorized to drop off or picking up your child from camp other than the Parent/Guardian listed above.
Authorized Adult Full Name #1
First Name
Last Name
Authorized Adult #1 Cell Phone Number
Please enter a valid phone number.
Authorized Adult #1's Relationship to Camper
ex. Grandmother
Authorized Adult Full Name #2
First Name
Last Name
Authorized Adult #2 Cell Phone Number
Please enter a valid phone number.
Authorized Adult #2's Relationship to Camper
ex. Grandmother
Authorized Adult Full Name #3
First Name
Last Name
Authorized Adult #3 Cell Phone Number
Please enter a valid phone number.
Authorized Adult #3's Relationship to Camper
ex. Grandmother
Let us know your questions!
This year is the Connect-2-Camp programs second year running and for many of you it may be the first time you are enrolling your child in camp. Please let us know any questions or concerns you may have below. If you think of them later you can always send questions to info.connect2camp@gmail.com
Questions for the Connect-2-Camp Staff:
Review & Sign
Please review this application before submitting. By signing below, you confirm that the information above is, to the best of your knowledge, accurate and consent to being contacted by our office to continue the registration process.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Signature
*
Submit
Should be Empty: