Gardner Camp Activity Request Form
Today's Date:
*
-
Month
-
Day
Year
Date Picker Icon
Name of Group/Organization
*
Date(s) / Time(s) of requested activity:
*
Group/Organization Status: (Select all that apply)
*
Not-for-Profit/501(c)3
Commercial/For Profit Organization
Private
State Licensed Agency
Group/ Organization Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact:
*
First Name
Last Name
Phone Number: (Work)
*
-
Area Code
Phone Number
Phone Number: (Cell)
*
-
Area Code
Phone Number
Email Address:
*
Email
Name of Requested Activity:
*
Purpose of Requested Activity:
*
Ex: Outdoor Education
Proposed Youth Attendance:
*
Approx. # of Youth
Proposed Adult Attendance:
*
Approx. # of Adults/Chaperones
Feel free to give us more information or ideas regarding your request here and we'll be sure to get back with you.
Save
Submit Request
Should be Empty: