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Camp Co-op

Parent Information

Name

Member or Account Number

Email

Phone

Address

Address 2

City/Town

State

ZIP/Postal Code

Child Information

Name(s)

Include all kids in your household

Age ranges

5-7

8-10

11-13

Interests

Math/Science

Construction

Cooking

Outdoors

Please include information for all children, ages 5-13, in your household.

I agree to the terms of service.

Camp Kit

I understand that only members are eligible to apply.
Please note that by providing your email, you are giving the cooperative permission to email you about important, account-related information (outages, balance due, cooperative updates, etc.) and in emergency situations.
I am a current member.
I am the parent/guardian of the children listed.
Medina EC holds no liability on the kits.
Each kit may be different.
It is encouraged to submit a photo of my child(ren) with their Camp Co-op Kit by email to MyCoop@MedinaEC.org.