Pine Island Camp Application
Thank you for your interest in joining our 2021 season! Please fill out the form below and we will be in touch with you shortly to schedule a time to meet with director Sumner Ford.

We currently have a wait list for camp. By filling out this form, your son will be added to the wait list. We will contact each applicant as spots become available.

Our 2021 Camp Dates are June 25 - August 8. Tuition for the 2021 season is $9200 if enrolled in our traditional camp program and $9700 if enrolled in Expedition Camp. As was true in 2020, if we cancel camp due to COVID-19 in 2021, your deposit and tuition will be fully refundable.
Camper's Full Name *
Name he goes by (if different)
Grade to be Completed this spring *
Age on June 25, 2021 *
Date of Birth *
Parent #1 Name *
Parent #1 Cell Phone *
Parent #1 Home Phone
Parent #1 Email *
Parent #1 Street Address *
Parent #1 City, State Zip *
Parent #2 Name
Parent #2 Cell Phone
Parent #2 Home Phone (if different than Parent #1)
Parent #2 Email
Parent #2 Street Address (if different than Parent #1)
Parent #2 City, State Zip (if different than Parent #1)
Other Contact Person, Relationship, and Phone number
How would you like to meet with Camp Director Sumner Ford? *
Sumner meets with all new camp families.
Required
How did you learn about Pine Island Camp? *
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