Camp Green Lane: Alumni Online Form

In accordance with the Children's Online Privacy Protection Act, a person must be 13 years of age or older to complete and submit this form.

First Name:

Middle Name:

Last Name:

Maiden Name:

Date of Birth:

(MM/DD/YY)

Alumnus Occupation:

Position, Company:

What years were you a camper?

(e.g. 1980 - 84, 86)

What years were you on staff?

(e.g. 1980 - 84, 86)

Spouse First Name:

Spouse Middle Name:

Spouse Last Name:

Spouse Occupation

Position, Company:

Is Spouse an Alum? Yes No If yes, maiden name (if applicable):

Date of birth:

(MM/DD/YY)

What year was your spouse a camper?

(e.g. 1980 - 84, 86)

What year was your spouse on staff?

(e.g. 1980 - 84, 86)

Contact Information

Number and Street

City and State:

Zip Code:

Home Telephone #:

Work Telephone #:

(spouse)

Email Address:

Fax #:

Children

Child #1 Name:

DOB:

Boy Girl

Child #2 Name:

DOB:

Boy Girl

Child #3 Name:

DOB:

Boy Girl

Would you like to receive information on camp for your children? Yes No

Would you like to receive information on staff positions for someone in your family? Yes No

Do you know of another camp alumnus who should be in our Alumni Directory? Yes No

If yes, please fill out the fields below:

Alumnus First Name:

Alumnus Middle Name:

Alumnus Last Name:

Alumnus Contact Information:

Home Address:

City and State:

Zip Code:

Home Telephone #:

Work Telephone #:

E-mail address:

Fax Numer:

Please share with us any news about yourself, your family and any special memories of camp you remember fondly:

Summer Office (after June 10):

249 Camp Green Lane Road
Green Lane, PA 18054
215-234-8666

Winter Office:

1000 Germantown Pike, F-3
Plymouth Meeting, PA 19462
610-270-1700

Email: melcgl@aol.com