Request Info - Park Shore Country Day Camp

Park Shore Information Request

What Program(s) Are You Interested In?*
Day Camp
Flexible Day Camp
Travel Camp Programs (Grades 6-9)
Toddler Day Camp Program
Extreme STEAM Science Kids Camp
Sports Track
Circus Academy
Preschool School Program
Kindergarten
Toddler School Program
Extreme STEAM Science Kids After School or Weekend Program
Preschool & Kindergarten After School Programs

Contact Information

First Name*

Last Name*

Email*

Place of Work*

Mobile Phone*

Home Phone

Address*
Street Address Address Line 2 City State ZIP Code

Child 1 Information

Child 1 Name

Child 1 Birthdate

Grade Completed as of Coming June

Child 2 Information

Child 2 Name

Child 2 Birthdate

Grade Completed as of Coming June

Child 3 Information

Child 3 Name

Child 3 Birthdate

Grade Completed as of Coming June

Additional Information

How did you hear about us? Please check all that apply.*
Google
Facebook
Instagram
Yelp
LongIsland.com
Mommy Poppins
Long Island Parent
Macaroni Kid
Living Huntington
Advertisement
Through your place of work
Friend/Relative
Park Shore Employee
Drove by
Other

If "Other," Please Specify

Name of Company

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Additional Comments or Questions

Name
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