Timber Lake Camp : Request Info : Request Info

If you would like further information about our programs, we'll be glad to send you a video and brochure. Please fill out the form below and you'll receive material from us within a week: Please provide the following information. (*) denotes a required field.

Relation:	*	Relation:
First name:	*	First name:
Last name:	*	Last name:
Work Phone:	*	Work Phone:
Cell Phone:		Cell Phone:
E-mail:	*	E-mail:

Address line 1:	*	Zip:	*
Address line 2:		Country:	*
City:	*	Home Phone:	*
State:	*	Session interest:	*

Child 1		Child 2
First name:	*	First name:
Last name:	*	Last name:
Gender:	Male Female*	Gender:	Male Female
Date of Birth:	*	Date of Birth:
Grade: (as of next September)	*	Grade: (as of next September)
School:	*	School:
Child 3		Child 4
First name:		First name:
Last name:		Last name:
Gender:	Male Female	Gender:	Male Female
Date of Birth:		Date of Birth:
Grade: (as of next September)		Grade: (as of next September)
School:		School:

Questions? Please email: