2020 Summer Camp/ Program Directory Form

Our Camp & Summer Program Directory is available to all summer camps and programs and runs March through June as a continual resource for parents.

Cost: $75 per issue or $125 for both

Deadline: February 10th (March/April Issue) & April 13th (May/June) Issue

Sign up here:

Business Information
Please note that this section is for internal records only.
Business Name*
Name

First

Last
Email
Phone
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Frequency & Schedule

Select the months you would like to run your directory advertisement.
Campaign Schedule*
- March/April Issue
- May/June Issue
- Both
Directory Text Information

The information you put in this section below will be placed in the magazine as you complete it. Please fill it out exactly as you would like listed.

If you leave a field blank, it will not be listed, so we recommend that you use all fields available to your advantage.
Summer Camp or Program Name*
Camp Category*

You must select ONE category.
Basic Category
- Academic
- Adventure/ Outdoor
- Arts
- Before/After School Program
- Religious
- Special Needs
- Sports
- Traditional
- Travel
- Winter/Spring Break Program
Please select all that apply. Note that this section will appear on the website only.
Camp Contact/ Title*
Camp Contact Email
Website
Camp Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code
Camp Phone
Dates of Camp
50 Word Description*

Longer entries will be edited at the Editor’s discretion. Do not repeat information that is already listed in other areas of your directory listing.

</div> </li> <li id="field_197_19" class="gfield gfield_contains_required field_sublabel_below field_description_below"><label class="gfield_label">How would you like to pay?<span class="gfield_required">*</span></label> <div class="ginput_container"> <ul class="gfield_checkbox" id="input_197_19"> <li class="gchoice_197_19_1"> <input name="input_19.1" type="checkbox" value="Invoice" id="choice_197_19_1" tabindex="44"/><label for="choice_197_19_1" id="label_197_19_1">Invoice</label> </li> <li class="gchoice_197_19_2"> <input name="input_19.2" type="checkbox" value="Credit Card" id="choice_197_19_2" tabindex="45"/><label for="choice_197_19_2" id="label_197_19_2">Credit Card</label> </li> <li class="gchoice_197_19_3"> <input name="input_19.3" type="checkbox" value="This is apart of a package" id="choice_197_19_3" tabindex="46"/><label for="choice_197_19_3" id="label_197_19_3">This is apart of a package</label> </li> </ul> </div> <div class="gfield_description">Please select from list below. If you are prepaying via credit card, please continue with the Credit Card Submission Form below (note that you will need to hit the “Submit” button here and then again when you are ready to submit your final directory form.</div> </li> <li id="field_197_25" class="gfield gsection field_sublabel_below field_description_below"> <h2 class="gsection_title">Credit Card Information</h2> </li> <li id="field_197_41" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_41_3">Name on Card</label> <div class="ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix" id="input_197_41"> <span id="input_197_41_3_container" class="name_first"><br /> <input type="text" name="input_41.3" id="input_197_41_3" value="" tabindex="48"/><label for="input_197_41_3">First</label><br /> </span><br /> <span id="input_197_41_6_container" class="name_last"><br /> <input type="text" name="input_41.6" id="input_197_41_6" value="" tabindex="50"/><label for="input_197_41_6">Last</label><br /> </span> </div> </li> <li id="field_197_29" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_29">Billing Zip Code</label> <div class="ginput_container"><input name="input_29" id="input_197_29" type="text" value="" class="medium" tabindex="52"/></div> </li> <li id="field_197_26" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_26">Credit Card Numbers</label> <div class="ginput_container"><input name="input_26" id="input_197_26" type="text" value="" class="medium" tabindex="53"/></div> </li> <li id="field_197_27" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_27">Expiration Date</label> <div class="ginput_container"><input name="input_27" id="input_197_27" type="text" value="" class="medium" tabindex="54"/></div> </li> <li id="field_197_30" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_30">CVV</label> <div class="ginput_container"><input name="input_30" id="input_197_30" type="text" value="" class="medium" tabindex="55"/></div> </li> <li id="field_197_31" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_31">Credit Card Type</label> <div class="ginput_container"><select name="input_31" id="input_197_31" class="medium gfield_select" tabindex="56"><option value="Mastercard">Mastercard</option><option value="Visa">Visa</option><option value="Discover">Discover</option><option value="American Express">American Express</option></select></div> </li> <li id="field_197_23" class="gfield gfield_contains_required field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_23">Advertising Representative<span class="gfield_required">*</span></label> <div class="ginput_container"><select name="input_23" id="input_197_23" class="medium gfield_select" tabindex="57"><option value="Choose Your Rep Here">Choose Your Rep Here</option><option value="Mary Cox">Mary Cox</option><option value="Hannah Mohler">Hannah Mohler</option><option value="Brooke Litherland">Brooke Litherland</option><option value="I don't know">I don’t know</option></select></div> <div class="gfield_description">For internal records, we need to know the advertising representative from Cincinnati Parent with whom you are working.</div> </li> <li id="field_197_22" class="gfield gsection field_sublabel_below field_description_below"> <h2 class="gsection_title">Terms and Conditions</h2> <div class="gsection_description">I fully understand that this advertising contract is subject to the schedule and payment amount set forth above to be prepaid in full or prior to publication. The liability of the publisher for any error or omission for which it may be held legally responsible shall in no way exceed the cost of the space paid for and occupied by such advertisement. Oral agreements are non-binding. Cancellations must be submitted in writing by the first of the month prior to the scheduled advertisement. I have the authority to execute this contract and take full financial responsibility for the total amount incurred (including but not limited to collection fees, past due charges, production fees, if applicable) on behalf of the above named company and authorize Midwest Parenting Publications, LLC to publish advertising as noted above.</div> </li> <li id="field_197_32" class="gfield field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_32">Notes/ Questions</label> <div class="ginput_container"> <textarea name="input_32" id="input_197_32" class="textarea medium" tabindex="58" rows="10" cols="50"/></div> </li> <li id="field_197_24" class="gfield gfield_contains_required field_sublabel_below field_description_below"><label class="gfield_label" for="input_197_24">Your Signature of Agreement and Today’s Date<span class="gfield_required">*</span></label> <div class="ginput_container"><input name="input_24" id="input_197_24" type="text" value="" class="medium" tabindex="59"/></div> <div class="gfield_description">I agree to all terms and conditions listed above and within this contract with this digital signature. (Please type name in the field above).</p> <p> Please review all information before you click “Submit.” Once you click this button your information will be sent. 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2020 Summer Camp/ Program Directory Form

Sign up here:

Frequency & Schedule

Directory Text Information