Promo Request Form

 

Internet Special
Limited Time Only - Register 2 campers and get the 2nd one at half off!

Please fill the form below and someone from our office will contact you to complete enrollment.

Parent First Name
Parent Last Name
Street Address:
City, State, Zip Code
Child #1 Name
Child #1 Birthdate
Child #2 Name
Child #2 Birthdate

Home Phone Number
Work Phone Number
Cell Phone Number
Email Address
Camp Location(s)
Camp Date(s)
Children's School(s)
Where did you hear about Mad Science Summer Camps?