Request Info

In accordance with the Children's Online Privacy Protection Act, a person must be 13 years of age or older to complete and submit this form.

Camp Redwood On-Line Request Form
Please Fill Out & Complete All Fields
Note: Use "TAB" Key and/or Pointer to Move Between Fields.

Request For:	Video Brochure
	Brochure in Print

Parent's Information

Parent's First Name:
Parent's LastName:

Address:
City:
	State: ZIP:

Home Phone #:
Work Phone #:
Cell/Mobile #:
Email Address:

Child's Name and Birthdate

1. Full Name:
1. Birthdate:
1. Current Grade:

2. Full Name:
2. Birthdate:
2. Current Grade:

3. Full Name:
3. Birthdate:
3. Current Grade:

Additional Comments and/or Information:



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