Camp Modin - Request Information

Thank You

Your information request has been successfully submitted. A member of the Modin team will reach out to provide you with additional information and to set up a time to speak. Should you have any immediate questions, please feel free to call or email us at any time at +1.207.465.4444 or info@modin.com. We look forward to speaking with you and becoming acquainted with your family.

Best regards,

Howard, Lisa, & Samara
Directors

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Information Request

To be completed by a parent/legal guardian ONLY. If you are under the age of 13, please click here.

* required field

First Parent/Guardian Information

Role / Relationship to child(ren):

Title:

* First Name:

* Last Name:

* Email:

* Home Phone:

Cell/Mobile Phone:

Second Parent/Guardian Information

Role / Relationship to child(ren):

Title:

First Name:

Last Name:

Email:

Home Phone (only if different):

Cell/Mobile Phone:

* We are exploring camp for the summer of:

Home Address

* Country:

* Address:

* City:

* State/Province:

* Zip/Postal Code:

First Child's Information

* First Name:

* Last Name:

* Date of Birth:

* Current Age:

Previous camp experience:

* Current school:

* Current grade:

* Gender:

Male Female Other

Other gender (optional):

Interests:

Second Child's Information

First Name:

Last Name:

Date of Birth:

Current Age:

Previous camp experience:

Current school:

Current grade:

Gender:

Male Female Other

Other gender (optional):

Interests:

Third Child's Information

First Name:

Last Name:

Date of Birth:

Current Age:

Previous camp experience:

Current school:

Current grade:

Gender:

Male Female Other

Other gender (optional):

Interests:

Final Questions

How did you hear about Camp Modin?

Please specify:

Additional comments:

Website:

Children's privacy is of primary concern to us, and our policy and practices reflect applicable laws and regulations on children's privacy, including the Children's Online Privacy Protection Act (COPPA). We do not knowingly collect personal information from children under 13 years of age. Any communication we receive that is identified as being from a child under 13 will be immediately removed from our database. Should a parent suspect that a child under the age of 13 has provided us with information, that parent may write to us to review said information, request that it be deleted, and opt out of future collections. We urge parents to regularly monitor and supervise their children's on-line activities. All information gathered from prospective and current camp families is stored securely, and used exclusively for camp, and not provided to third-party vendors.