Choose the program you are registering for:*Grandparent Camp: July 29th - August 1st (3 night program)Grandparent Camp: August 5th - August 7th (2 night program)Family Camp: September 2nd - September 5th (3 night program)Dad & Me Camp: September 16th - September 18th (2 night program)Primary ContactFirst Name*Last Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Email* Phone*Family InformationPlease fill out the following details on your family members. Include all individuals that will be paying under the same account. Each individual listed must have a mother, father, uncle, aunt or grandparent attending or they must have a son, daughter, niece, nephew, grandson or grandaughter attending:Number of adults*123Number of children:*12345Adult #1Adult #1 Full Name*Adult #1 Date of Birth* Adult #1 Swimming Ability*BeginnerIntermediateAdvancedAdult #2Adult #2 Full Name*Adult #2 Date of Birth* Adult #2 Swimming Ability*BeginnerIntermediateAdvancedAdult #3Adult #3 Full Name*Adult #3 Date of Birth* Adult #3 Swimming Ability*BeginnerIntermediateAdvancedChild #1Child #1 Full Name*Child #1 Date of Birth* Child #1 Swimming Ability*BeginnerIntermediateAdvancedChild #2Child #2 Full Name*Child #2 Date of Birth* Child #2 Swimming Ability*BeginnerIntermediateAdvancedChild #3Child #3 Full Name*Child #3 Date of Birth* Child #3 Swimming Ability*BeginnerIntermediateAdvancedChild #4Child #4 Full Name*Child #4 Date of Birth* Child #4 Swimming Ability*BeginnerIntermediateAdvancedChild #5Child #5 Full Name*Child #5 Date of Birth* Child #5 Swimming Ability*BeginnerIntermediateAdvancedDietary restrictions, allergies and/or medical conditionsDoes anyone in your family have any dietary restrictions and/or allergies?*YesNoDietary restriction and/or allergy information:*Does anyone in your family have any medical conditions that would prevent them from participating in camp activities?*YesNoMedical condition information:*Emergency Contact InformationPlease provide the emergency contact details of someone who will not be attending camp with you:Emergency Contact Name*Their relationship to primary contact:*Home Phone:*Cell Phone:*Email* Additional InformationIf this is your first time attending one of our camps, how did you hear about NYQUEST Family Camps and Grandparent Camps?Are any of the Adults in your family a Doctor or Medical Professional? If so, please list the adult's names and their profession:If you would like to share your cabin, please list these individuals below:For individuals registering for Family Camp or Dad and Me Camp there is a 10% discount if you share a cabin with another family. They must also list you on their registration form: This iframe contains the logic required to handle AJAX powered Gravity Forms.