Camp Mangan 2021 Registration
Camper Information
Camper's Name
*
First Name
Last Name
Age
*
T-Shirt Size
*
Ex. Youth M
Gender
*
Male
Female
Returning Camper
*
Yes
No
Days attending (Choose full week or individual days if not attending the full weeks)
Full Week 1
Full Week 2
Full Week 3
21st
28th
5th
22nd
29th
6th
23rd
30th
7th
24th
1st
8th
25th
2nd
9th
Add another child?
*
Yes
No
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Next
Second Child
Please enter the information for your second child. If you only have one child click back and select "no" on the "Any additional children" question.
Camper's Name
*
First Name
Last Name
T-Shirt Size
*
Ex. Youth M
Age
*
Gender
*
Male
Female
Returning Camper
*
Yes
No
Days attending (Choose full week or individual days if not attending the full weeks)
Full Week 1
Full Week 2
Full Week 3
21st
28th
5th
22nd
29th
6th
23rd
30th
7th
24th
1st
8th
25th
2nd
9th
Add another child?
*
Yes
No
Back
Next
Third Child
Please enter the information for your third child. If you only have two children click back and select "no" on the "Any additional children" question.
Camper's Name
*
First Name
Last Name
T-Shirt Size
*
Ex. Youth M
Age
*
Gender
*
Male
Female
Days attending (Choose full week or individual days if not attending the full weeks)
*
Full Week 1
Full Week 2
Full Week 3
21st
28th
5th
22nd
29th
6th
23rd
30th
7th
24th
1st
8th
25th
2nd
9th
Returning Camper
*
Yes
No
Add another child?
*
Yes
No
Back
Next
Fourth Child
Please enter the information for your Fourth child. If you only have three children click back and select "no" on the "Any additional children" question.
Camper's Name
*
First Name
Last Name
Age
*
T-Shirt Size
*
Ex. Youth M
Gender
*
Male
Female
Days attending (Choose full week or individual days if not attending the full weeks)
*
Full Week 1
Full Week 2
Full Week 3
21st
28th
5th
22nd
29th
6th
23rd
30th
7th
24th
1st
8th
25th
2nd
9th
Returning Camper
*
Yes
No
Back
Next
Parent/Guardian Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
Alt. Phone Number
Does the Camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
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Next
Payment
You can pay the total with one of the options below.
Venmo
Andrew-Mangan-2 (Please include the child's name in the description)
Paypal
admangan2018@gmail.com (Please include the child's name in the description)
Check
Mail a check to: Andrew Mangan PO Box 880 Derby, NY 14047
Submit
Should be Empty: