Create an Account
= Required Field

Account Type

Select Account Type:

Primary Contact for account

Enter the information for the primary contact for this account. This person must be an adult.
First Name:

Last Name:

Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:

City:

State / Province:
*
Zip / Postal Code:

Primary Phone
*



Alternate Phone:
*



Alternate Phone 2:



Email Address:
*
Confirm Email Address:
*

Additional Contact for account

Add an additional contact for this account by completing the information below.
This person is:
First Name:
Last Name:
Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:
 
City:
State / Province:
Zip / Postal Code:
Primary Phone:


Alternate Phone:
Alternate Phone Ext:

Alternate Phone 2:

Email Address:
Confirm Email Address:


Additional Information

Please provide the following information
Is your child a first time camper for Summer Camp at COH?


If Yes, how did you hear about us? Family/Friend (please list names), Facebook, Advertisement, Instagram, Twitter or anything else.
Please briefly explain why you chose Camp Orchard Hill? (Price, Values, Staff, Program or other)
Please tell us what you are hoping for from your camper's experience at COH?

Login Information

The username and password must consist only of letters and/or numbers.  No special characters or spaces are allowed.
Username:
Password:
*
Confirm Password:
*
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640 Orange Road • Dallas • PA • 18612 • 5703334098
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