Southern California 401 S. Ivy Street Escondido, CA (P) (F)

Size: px
Start display at page:

Download "Southern California 401 S. Ivy Street Escondido, CA (P) (F)"

Transcription

1 = 2015 Creating solutions, changing lives. Services for children and adults with disabilities in Southern California Easter Seals Southern California (P) (F) Dear Parents and Campers, Easter Seals camp will be held August 2nd through August 8 th at YMCA Camp Oakes in the San Bernardino Mountains. Our theme will explore college life and be called Camp University". You are automatically guaranteed ACCEPTANCE at camp if you complete and return the below documents by April 30, If the below items are NOT returned before April 30th, you are not automatically guaranteed a spot and we will notify you as we process applications whether we have space to accept you or not. The documents to be completed and returned by April 30 th for a guaranteed spot are: Camp Application Financial Statement (with payment or a campership request) Transportation Form The Medical Form must be completed and returned by July 15, Please complete the medication section of the 2 page Medical Form and have the doctor confirm those medications or update the list when you have your doctor's appointment. Please list ALL medications, vitamins, supplements, etc. that you will be bringing to camp. Check-in at camp will be delayed if there is a discrepancy between the Application/Medical Form and the items brought to camp. The fee charged to campers is $750. The actual cost per camper is $1,126 but Easter Seals subsidizes $376 per camper by raising donations. If you are able to pay more than $750, we appreciate you doing so. If you have difficulty paying $750, we encourage you to solicit donations and some partial camperships are available. A donation guide and form are enclosed should you need assistance in soliciting donations. Regional Center will not cover the cost of Camp. We thank you for your interest in Easter Seals camp and should you have any questions, please contact me at amanda.showalter@essc.org or Sincerely, Amanda Showalter Camp Director

2 Easter Seals Southern California RESIDENT CAMP APPLICATION Sunday, August 2nd thru Saturday, August 8th 2015 (PLEASE PRINT) Camper s Last Name First Name Nickname Camper s Diagnosis Conserved: Yes No ( ) Home Telephone Camper Address for official correspondence, if different Street Address City Zip M F Age Birthday Developmental Age Language spoken at home ( ) ( ) ( ) Primary contact Home Phone Work Phone Cell Relationship ( ) ( ) ( ) Secondary contact Home Phone Work Phone Cell Relationship ( ) ( ) ( ) Conservator s Name (if applicable) Home Phone Work Phone Cell/Pager Will parent/guardian/conservator be away from home during the camp week? Yes No If yes, where? Phone # ( ) In an emergency, if parent/guardian/conservator cannot be reached, notify: Name: Phone ( ) Relationship to Camper: Name: Phone ( ) Relationship to Camper: Name: Phone ( ) Relationship to Camper: 1 of 8

3 Is there any special assistance needed with eating or dressing? If so, please describe: Is there any special assistance needed with toileting? If so, please describe bowel regimen (pattern/frequency/max # of days w/o B.M.; is constipation common?) Have there been any changes to health or general well-being in the past year? If so, please list: If there are any physical conditions, past operations or injuries which should restrict camp activity, please specify: If the camper is in school, works or participates in group activities, please provide details: Does the camper require special night care? Yes No If yes, please specify: Does the camper sleep through the night? Yes No If no, please specify: Does the camper exhibit self-abusive behavior or dangerous tendencies that could result in harm to him/herself or others? Yes No If yes, please specify: Is there anything else that you would like us to know? Is camper taking medication? Yes No If yes, please list all medications (INCLUDING vitamins, supplements, etc.). Please provide a comprehensive list. Breakfast Lunch Dinner Bedtime Drug Name strength/ concentration 2 of 8

4 Media Consent I give my permission for Easter Seals and anyone connected to Easter Seals to use any descriptions, stories, pictures, photographs, recordings of the person named above or things he or she says or does. Easter Seals may use these materials in print, broadcast, on the Web or any other medium and these may be released to the general public at any time. I give Easter Seals all rights to these materials. All of these materials made by Easter Seals are owned by Easter Seals and may be protected by a copyright. I also understand I will not be compensated in any way for use of the material Consent to Administer Prescription Medication I give permission for the camp nurse to administer the prescribed medications listed on the enclosed physician s form, per the doctor s orders listed on the prescription bottle/container. NOTE: All medications must be provided in original containers with unaltered labels Consent to Administer Over-The-Counter Medication I give permission for the camp nurse to administer over-the-counter medication if the nurse and/or consulting physician deem it necessary. Dosages will be administered according to age/weight per directions on the box/bottle unless a physician directs otherwise. Sample OTC medication and reasons for use below: Pain / fever or inflammation.tylenol/jr., Ibuprofen/Jr. Upset stomach, nausea Pepto Bismol, Tums, Maalox Diarrhea..Immodium AD Constipation Milk of Magnesium Insect / plant, skin irritations.calamine Lotion, Cortaid Minor allergy relief..benadryl/jr., Sudafed Cough / cold symptoms...robitussin, Chloroseptic Spray,Tylenol Cough & Cold/Jr. Motrin Cough & Cold/Jr. or equivalents Authorization for Emergency Treatment In case of medical or dental emergency, I/we understand every effort will be made to contact the parents/guardian/conservator of the individual (if applicable). If parent(s)/guardian(s)/conservator cannot be reached I/we authorize the Easter Seals and its' staff as agent for the undersigned, to obtain and consent to x-ray, examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered to said program participant under the general or special supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act or the medical staff of a licensed hospital or by a dentist licensed under the provisions of the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist or at said hospital. I/We understand and agree that Easter Seals has no insurance covering such medical or hospital care. Costs incurred for such treatment shall be mine or my parent(s)/guardian(s)/conservator's sole responsibility. It is understood that this authorization is given in advance of any specific medical or dental diagnosis, treatment or care being required but is given to provide authority and power on the part of Easter Seals, to give specific consent to any and all such diagnosis, treatment or care which a licensed physician or dentist in the exercise of their best judgment may deem advisable in an emergency. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California, and California State Education Code Section Personal Property The undersigned recognizes that neither Easter Seals nor the YMCA of Greater Long Beach/Camp Oakes can accept responsibility for camper s personal property. To reduce losses, the undersigned has ensured that a list of belongings has been attached to camper s luggage. I CONSENT/AGREE TO ALL OF THE ABOVE. Camper/Parent/Guardian/Conservator Signature Date Print Name If adult camper has a conservator, the conservator must sign all forms where signature is requested. If adult camper is legally responsible for him/herself, camper signs ALL signature lines where signature is requested. 3 of 8

5 EASTER SEALS SOUTHERN CALIFORNIA FINANCIAL STATEMENT The cost of sending a camper to Camp Oakes is $1,126. Easter Seals subsidizes every camper and the amount you are responsible for paying is $750. If you are unable to pay the full $750, campership funds are available, on a limited basis, for those who qualify based on income guidelines. All campers are encouraged to assist Easter Seals in raising funds by asking friends, neighbors and local businesses for contributions. A donation form is enclosed for campers who are able to raise donations. ======================================================================== Section 1 This section must be completed for all campers. Camper s Name: Check the following that apply: I will pay the full camp fee of $750. Payment is enclosed. I will pay the full camp fee of $750 and make an additional donation of I will need partial campership assistance. (Section 2 must be completed.) No refunds will be made if camper leaves camp because of homesickness, behavior problems or is sent home by the camp nurse. To pay by check, make the check payable to Easter Seals. To pay by credit card, circle one: Visa MasterCard Discover American Express Cardholder s Name (PRINT) Account Number Expiration Date Cardholder s Signature: TOTAL Amount to be charged: ======================================================================== Section 2 If you are requesting partial campership assistance. You will need to put your request in writing. Include your annual household income, the number of people who live in your house and the amount that you are requesting in campership funds. Please note that not all campership requests can be granted. Campership funds will be offered on a first come first served basis and Easter Seals will make every attempt to spread the money available around to as many campers as possible. - Without this information, campership funding cannot be granted. - A minimum payment of $400 is required for all campers receiving campership funding. Please send your written request for a campership with the other forms to Easter Seals via: Scan/ to camp@essc.org (preferred method) Fax to Mail to: Easter Seals Southern California, 401 S. Ivy St, 4 of 8

6 EASTER SEALS SOUTHERN CALIFORNIA Amanda Cell TRANSPORTATION Easter Seals can only provide limited bus transportation to those returning campers who have no other means of transportation. The family needs to provide transportation to and from camp if at all possible. The fee for bus transportation is: $80.00 round trip or $40.00 one way. Fee must be paid by July 6, For campers providing their own transportation, Drop off at camp is at 10:00 am on Sunday, August 2nd. Lunch will be provided. Please pick up from camp on Saturday August 8th between 9:00 a.m. and 9:30 a.m. For those campers taking the bus, Campers needing transportation must meet at Easter Seals Riverside office by 11:30 a.m. on Sunday, August 2nd. More information with regards to the Riverside office location will follow in the coming months. Departure from camp is at 10:00 a.m. on Saturday, August 8, The approximate arrival time back at the Easter Seals Riverside Office is 12:00 p.m. Breakfast on Saturday is the last meal served at camp. Please complete: I will provide transportation for the camper I will need transportation provided by Easter Seals August 2, 2015 August 8, 2015 If you need transportation provided by Easter Seals, answer the next questions. Does camper use a wheelchair? Yes No If yes, can camper transfer? Yes No If yes, can the wheelchair break down? Yes No If yes, is it electric or manual? Elec Man 5 of 8

7 EASTER SEALS/ YMCA CAMP OAKES Camper Medical Form 2015 This form must be reviewed and signed by a physician. Return the form to Easter Seals by July 15, Scan/ to camp@essc.org (preferred method) Fax to Mail to: Easter Seals Southern California, 401 S. Ivy St, Camper cannot attend camp without a completed and signed medical form before check-in day. Camper s Name: Medical Diagnosis: Medical History and Restrictions: 1) Has there been any recent exposure to a contagious disease or is the patient a carrier of a contagious disease? YES NO If yes, please explain. 2) How would you assess the applicant s current health? (CIRCLE) GOOD FAIR POOR 3) List any chronic health problems (e.g. asthma, pressure sores, cough, constipation) and treatments of which the medical staff should be aware: 4) Does the applicant have any known allergies? YES NO If yes, please describe. 5) Does the applicant have seizures? YES NO If yes, Current status: (i.e. active, controlled): Type of seizure: How often: 6) Has the applicant been hospitalized or treated in an emergency room recently? YES NO If yes, please explain. 7) Are there any physical conditions, past operations or injuries which should restrict camp activity? YES NO If yes, please explain and list any restricted area. 8) Please list any dietary restrictions. 9) Standing BP As needed medications: List any medications that are taken as needed (i.e. for headaches, heartburn, menstrual cycle) specifying the name of the drug, frequency and the corresponding dosage. *Please bring these medications. Drug Name Strength Dose Frequency 6 of 8

8 NEW CAMPER APPLICATION Scheduled Medications: (Oral Medications, Vitamins, Supplements: List ALL of the oral medications, vitamins, supplements camper is currently taking on a regular basis.) *Please bring these medications. strength/ Breakfast Lunch Dinner Bedtime Drug Name concentration Example Drug XYZ 1 pill = mg 1 pill NA 2 pills NA Liquid Medication 1 ml = mg 5 ml 5 ml 5 ml NA YES NO Do you give medications at any other times of the day or night? If yes, list medications and times. Please try to adhere to the administration times noted above, unless a medication must be given at a different time for medical necessity. PHYSICIAN S CONSENT AND SIGNATURE When seen by me on this date, the above named applicant was free from any contagious or infectious diseases or conditions and is capable of participating in the summer camp program(s) offered at Easter Seals/ YMCA Camp Oakes Physician Signature: Date: Physician s Name (Please Print): Office Phone: Emergency Phone: Address, City, State, Zip: 7 of 8

9 Final Check List Please be sure to submit the following forms: 1. Resident Camp Application (pages 1-5) 2. Medical Form (pages 6 & 7) The Medical Form must be completed and signed if you are notified that the camper has been accepted to attend camp. The Medical Form is reviewed and signed by a physician and does not need to be submitted with the other documents. The Medical Form must be returned to Easter Seals by July 15, TOTAL 5 pages (without Medical Form) TOTAL 7 pages (with Medical Form) Please submit the forms by one of the following methods: Scan/ to camp@essc.org (preferred) Fax to Mail to: Easter Seals,, For questions about camp, contact Amanda Showalter at Easter Seals at (951) or amanda.showalter@essc.org. Please note, applications that are not complete will be returned 8 of 8

10 Spring 2015 Dear Camper, Creating solutions, changing lives. Services for children and adults with disabilities in Southern California Donation Guide Easter Seals Southern California (P) (F) The fee to attend Easter Seals Camp Oakes is $750. If you qualify for a Campership the minimum cost is $400. Easter Seals understands that this expense may be difficult for some to incur. If this is the case, please consider soliciting donations as a means to cover these costs. In the past, many campers have solicited donations from businesses in their community that they often frequent. Some examples of this are banks, grocery stores, and churches. Many businesses have a Matching Gift Program, where an associate will make a donation and the business will match the money donated. Washington Mutual and Wal-Mart are two such places. My suggestion when asking for a camp donation from area businesses would be to: 1. Visit the store in person. 2. Ask to speak with the store manager or community relations department. 3. Tell them about Camp Oakes 4. Let them know how much camp means to you or how much you would like to attend. 5. Bring pictures of your past camp week, if you have them. 6. Share your favorite camp stories. In addition, many campers have turned to friends and family for donations. Ask an aunt, uncle, cousin, grandparent, your pastor and any close friends to donate $ $ These small donations will add up quickly. Is your birthday coming up? If so, ask for a donation to camp instead of a birthday present. If you have any questions, or need more suggestions on how to ask for donations, please feel free to call me or me at Amanda.showalter@essc.org I am more than happy to help guide you. Thank you, Amanda Showalter Coordinator of Camp Oakes

11 NEW CAMPER APPLICATION Easter Seals Southern California Donation Form CAMPER NAME: You Can Help! Please support children and adults with disabilities who cannot afford on their own to go to camp. This very special camp helps them enjoy, learn, grow and be challenged. Please make donations to: Easter Seals Resident Camp Program * Please reference camper s name. Resident Camp Activities: Crafts, boating, fishing, nature, archery, horseback riding, cooking, campfires, talent show, non-denominational chapels, special dinners, dances, and much more. Online Donation Credit card donations can be made at: When making the donation, please include camper s name you want to support. *If you are sponsoring a specific camper, please list camper name in the memo area of your donation check. *All donations should be clearly marked with your name, so that credit can be correctly applied. Sponsor/Donor Address Amount

Southern California 401 S. Ivy Street Escondido, CA (P) (F) 2018

Southern California 401 S. Ivy Street Escondido, CA (P) (F) 2018 = Easterseals Southern California 401 S. Ivy Street Escondido, CA 92025 951.264.4855 (P) 760.406.6048 (F) 2018 www.easterseals.com/southerncal Dear Campers and Parents Easterseals camp will be held August

More information

We thank you for your interest in Easterseals camp. Should you have any questions, please contact me at or

We thank you for your interest in Easterseals camp. Should you have any questions, please contact me at or 2017 Dear Parents and Campers, Easterseals camp will be held August 6th through August 12th at YMCA Camp Oakes in the San Bernardino Mountains. Our theme will explore science fiction and be called "Sci-Fi

More information

Creating solutions, changing lives. Services for children and adults with disabilities in Southern California

Creating solutions, changing lives. Services for children and adults with disabilities in Southern California 2015 Creating solutions, changing lives. Services for children and adults with disabilities in Southern California Easter Seals Southern California 401 S. Ivy Street Escondido, CA 92025 951 264 4855 (P)

More information

CAMP MCCUMBER. Overnight Camp. Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme

CAMP MCCUMBER. Overnight Camp. Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme CAMP MCCUMBER Overnight Camp Going into 3rd -9th Grade Camp Dates: Session I: July 8-July 14, 2018 Session II: July 29- August 4, 2018 Expedition Camp Theme 2018 OVERNIGHT CAMP YMCA Camp McCumber Registration

More information

Camp WAMP at Deer Lake CAMP APPLICATION 2018 SCHEDULE. Mail to: Shae Jewell 4848 Starflower Drive Martinez, CA

Camp WAMP at Deer Lake CAMP APPLICATION 2018 SCHEDULE. Mail to: Shae Jewell 4848 Starflower Drive Martinez, CA Camp WAMP at Deer Lake CAMP APPLICATION 2018 SCHEDULE Please check the session in which you wish to enroll. Mail to: Shae Jewell 4848 Starflower Drive Martinez, CA 94553 shae@wamplerfoundation.org CAMP

More information

Camper Authorization for Medical Treatment and Authorization to Pick-up Camper

Camper Authorization for Medical Treatment and Authorization to Pick-up Camper Camper Authorization for Medical Treatment and Authorization to Pick-up Camper Please return all 5 forms at least week before your first day of camp to: Inside the Outdoors, 200 Kalmus Dr., Costa Mesa,

More information

Camper Information. Street Address Apartment/Unit # City State ZIP Code. Parent/Guardian Information. Last First M.I. City State ZIP Code

Camper Information. Street Address Apartment/Unit # City State ZIP Code. Parent/Guardian Information. Last First M.I. City State ZIP Code Health History Form Parents / Guardians must complete all sections of this form apart from the final section which should be completed by the campers physician or a licensed medical personnel. Camper Information

More information

CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015

CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015 CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015 CAMPER INFORMATION Last First Middle Nickname _ Street Apt# City State Zip DOB Age Grade

More information

2018 Medical Waiver and Release

2018 Medical Waiver and Release 2018 Medical Waiver and Release I hereby give my consent to the Summer Camps at Avon Old Farms School personnel to provide, through a medical staff of its choice, customary medical attention and emergency

More information

Camp Hope Camper Health Information YEAR: 2017

Camp Hope Camper Health Information YEAR: 2017 Camp Hope Camper Health Information YEAR: 2017 PLEASE COMPLETE AND RETURN TO: Camp Magruder 17450 Old Pacific Hwy Rockaway Beach, OR 97136 PLEASE NOTE: Completely fill out, sign and date where requested.

More information

2019 Registration Form

2019 Registration Form Please include a $50 NONREFUNDABLE DEPOSIT for each camp. Please complete a separate form for each camper. For Office Use Only Please Print Legibly Parent/Guardian Information Relationship to Camper Relationship

More information

Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History

Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History First Name: _ Last Name: Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History Attending Camp Session(s) 1 2 3 4 5 6 7 8 LIT CIT Intern Staff The information on this form is not part

More information

Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280

Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280 Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280 REYOAD and Camp 139 Registration Form - 2018 Camp REYOAD

More information

Date Camper Name: LAST, FIRST (Please print) Medical Form

Date Camper Name: LAST, FIRST (Please print) Medical Form Date Camper Name: LAST, FIRST (Please print) Medical Form Medical information must be provided for you or your child to attend camp. To ensure the health and safety of our volunteer staff, adult and youth

More information

Camp St. Charles ANNUAL HEALTH FORM CHECKLIST

Camp St. Charles ANNUAL HEALTH FORM CHECKLIST Camp St. Charles ANNUAL HEALTH FORM CHECKLIST Parents, please use this handy checklist to help you organize your child s health information and prepare everything that needs to be mailed to Camp. HEALTH

More information

Camp Zanika Required Camper Forms

Camp Zanika Required Camper Forms Camp Zanika Required Camper Forms Every camper attending Camp Zanika must have a copy of the required forms. Forms can be found on our website, emailed, or mailed. All forms need to be returned to the

More information

Camper Health History form must be on file prior to arrival at NEMC

Camper Health History form must be on file prior to arrival at NEMC Dear NEMC Parent: Camper Health Form It is our privilege to care for your child while they are at camp. In order to do so safely and effectively, we ask that you use the checklist below to assure that

More information

Please circle shirt size and check Youth or Adult: Shirt Size S M L XL XXL 3XL other: 4-H Member is active in 4H Online:

Please circle shirt size and check Youth or Adult: Shirt Size S M L XL XXL 3XL other: 4-H Member is active in 4H Online: 2019 4-H Special Clovers Registration Packet March 23 & 24, 2019 DEADLINE: Registration is due in the State Office February 1 st Camp is limited to the 1 st 15 paid 4-H members Date: / / 2019 FOIC USE

More information

MARYLAND 4-H CAMPS HEALTH FORM

MARYLAND 4-H CAMPS HEALTH FORM MARYLAND 4-H CAMPS HEALTH FORM Camper s Name: _ Last First MI Nickname Current Photo Of Camper Male Female Age at Camp Arrival: Birthdate: Dates will attend Camp: to Street Address City State ZIP County

More information

2018 Camp OK Information and Forms

2018 Camp OK Information and Forms 2018 Camp OK Information and Forms Dear Club Leaders: It is time to again consider Camp OK as a club project and sponsor a child or children for this wonderful camping experience. This year the camp will

More information

Eastman Area 4-H Summer Camp

Eastman Area 4-H Summer Camp Eastman Area 4-H Summer Camp It s not too soon to be thinking about summer camp! Eastman Area will once again be holding a summer camp for Junior and Intermediate members, from August 25 th -30 th at beautiful

More information

Ben Lomond Quaker Center Summer Youth Camps Box 686, Ben Lomond, CA (831) ENROLLMENT FORMS

Ben Lomond Quaker Center Summer Youth Camps Box 686, Ben Lomond, CA (831) ENROLLMENT FORMS ENROLLMENT FORMS THESE FORMS MUST BE COMPLETED AND POSTMARKED NO LATER THAN JULY 2ND OR FAXED TO 831-336-0218 EQUIRED EMERGENCY INFORMATION Please PRINT legibly Camper's Name Sex: M F Birth date: / / Social

More information

MARYLAND 4-H CAMPS HEALTH FORM

MARYLAND 4-H CAMPS HEALTH FORM MARYLAND 4-H CAMPS HEALTH FORM Last First MI Nickname Current Photo Of Camper Male Female Home Address: Age at Camp Arrival: Birthdate: MM/DD/YYYY Dates will attend Camp: to MM/DD/YYYY MM/DD/YYYY Street

More information

FORM /GUARDIAN PLEASE HEALTH PARTICIPANT PROGRAM PARTICIPANT HEALTH FORM, CONT. TO BE COMPLETED BY PHYSICIAN ARENT/G CAMPER

FORM /GUARDIAN PLEASE HEALTH PARTICIPANT PROGRAM PARTICIPANT HEALTH FORM, CONT. TO BE COMPLETED BY PHYSICIAN ARENT/G CAMPER GLOW YMCA CAMP HOUGH PARTICIPANT HEALTH FORM TO BE COMPLETED BY PARENT ARENT/G /GUARDIAN PLEASE TE THE NEED FOR PHYSICIAN HYSICIAN S S SIGNATURES ON BOTH SIDES OF THIS FORM ORM. T ALL YMCA SUMMER PROGRAMS

More information

2018 Day Camp Dates See you this summer!

2018 Day Camp Dates See you this summer! DearKidsandParents, ItistimetogetreadyforCampRiseAbove!Weareexcitedtoinviteyouto our2018campsession,andhaveoutlinedbelowwhatourdayswillbe like.wehavealsoincludeda WhattoBring listonthebackofthispage. Ifyouwouldliketoattend,weaskyoutofilloutthe:

More information

CAMP MSC SENSATIONAL SUMMER SCIENCE

CAMP MSC SENSATIONAL SUMMER SCIENCE CAMP MSC SENSATIONAL SUMMER SCIENCE Thank you for choosing Camp MSC for your summer camp experience. Our camp programs are designed to be engaging, hands-on, challenging, and of course, fun! All full day

More information

Residential campers will report Sunday evening, and parents need to pickup Friday afternoon

Residential campers will report Sunday evening, and parents need to pickup Friday afternoon Thank you for registering your child to attend our fun-filled summer camps. Our camps are packed with many opportunities to learn, make friends with other Deaf or Hard of Hearing kids, and explore outlets

More information

SIBLING/FRIEND APPLICATION 2013

SIBLING/FRIEND APPLICATION 2013 SIBLING/FRIEND APPLICATION 2013 To be filled out by the parent/guardian of the friend/sibling. PERSONAL INFORMATION Name of Camper: Name of Primary Camper that he/she will be accompanying: Relationship

More information

Great Beaver Adventure Camp 2018 GIRL SCOUTING THROUGH THE YEARS

Great Beaver Adventure Camp 2018 GIRL SCOUTING THROUGH THE YEARS DATE: Thursday June 7, 2018 through Sunday June 10, 2018 TIME: THURSDAY THROUGH SATURDAY 8:30 AM to 4:30 PM SUNDAY ONLY- EARLY DISMISSAL 8:30 AM to 2:00 PM (PLEASE ARRIVE ON TIME) LOCATION - Carlisle YMCA

More information

IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS

IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS PLEASE NOTE OUR NEW LOCATION AT CAMP JOHN HOPE FFA-FCCLA CENTER IN FORT VALLEY, GA. 281 Hope Entrance Road, Fort Valley, GA 31030 Session One will be

More information

Peterkin Camp and Conference Center

Peterkin Camp and Conference Center Camper Information Peterkin Camp and Conference Center A Ministry of the Episcopal Diocese of West Virginia Summer Camp Registration Please complete one form per camper per camp. Check which camp your

More information

IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS

IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS IMPORTANT INFORMATION FOR CAMP BIG HEART APPLICANTS Session One will be Sunday, July 27 to Friday, August 1, 2014 (Winder, GA). The ages for this session are ages 7 to 28. Campers will be in cabins with

More information

CAMP PEP APPLICATION 2018

CAMP PEP APPLICATION 2018 Page 1 of 12 CAMP PEP APPLICATION 2018 Programs Employing People 1200 S. Broad St, Philadelphia, PA 19146 Phone: (215) 389-4006 FAX: 215-389-5228 E-mail: info@pepservices.org INSTRUCTIONS FOR COMPLETING

More information

IMPORTANT PLEASE READ

IMPORTANT PLEASE READ IMPORTANT PLEASE READ Please save these forms to your computer BEFORE filling them out. Then close the Internet and open the forms from where you saved them, and proceed to fill them in. After you have

More information

Overview. Camper Confirmation Packet Easter Seals Washington Camp Stand By Me

Overview. Camper Confirmation Packet Easter Seals Washington Camp Stand By Me Camper Confirmation Packet 2015 Email: campadmin@wa.easterseals.com Overview Welcome to the 2015 Season at Easter Seals Camp Stand by Me! This packet includes important paperwork that we need on file here

More information

CAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE

CAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE We have fun building GREAT kids! CAMP TAWINGO 2018 CAMPER APPLICATION FORM SUMMER FUN FOR BOYS & GIRLS 7 TO 16 YEARS OF AGE Please send this Application Form to: 1844 Ravenscliffe Rd Please check the session(s)

More information

Cave Springs Camp Registration Form

Cave Springs Camp Registration Form Cave Springs Camp Registration Form Camper Information (please use one form per camper) Camper s Name: (Last) (First) Birthday: (D/M/Y) Age: Gender: Does your child require 1:1 support? Yes No (Please

More information

Camper Application. DATE: Monday-Friday, June 18 - July 27 (Excluding July 4) 9 am - 12 noon. FREE! [Member] $20 [Non-Member]

Camper Application. DATE: Monday-Friday, June 18 - July 27 (Excluding July 4) 9 am - 12 noon. FREE! [Member] $20 [Non-Member] Camper Application Greetings Parents & Campers! The Greater Elizabethtown Area Recreation & Community Services is proud to announce our Camp Ladybug 2018 theme: Exploring Nature!! Camp is for individuals

More information

Lake Geneva Youth Camp Health Certificate

Lake Geneva Youth Camp Health Certificate Lake Geneva Youth Camp Health Certificate Camp Session This health form must be completed by the parent or legal guardian of the camper, and signed at the bottom. This form must be returned to the Camp

More information

2019 CAMP WARWICK R EGISTRATION FORM

2019 CAMP WARWICK R EGISTRATION FORM 2019 CAMP WARWICK R EGISTRATION FORM THIS FORM MUST BE COMPLETED BY PARENT/ GUARDIAN AND SUBMITTED WITH PAYMENT AND OTHER REQUIRED DOCUMENTS BEFORE REGISTRATION WILL BE ACCEPTED. THE PERSON REGISTERING

More information

2019 FAMILY CAMP Camper and Adult Registration

2019 FAMILY CAMP Camper and Adult Registration 2019 FAMILY CAMP Camper and Adult Registration Christian Church (Disciples of Christ) in Florida RETURN COMPLETED FORMS AND PAYMENT TO The Retreat at Silver Springs, 6455 E. Silver Springs Blvd., Silver

More information

Dates: 6/25-6/29 Monday - Friday (day camp 8:30am - 4:30pm)

Dates: 6/25-6/29 Monday - Friday (day camp 8:30am - 4:30pm) Green Mountain Camp for Girls Registration Return by 6/1/18 (or until sessions fill) Payment options: Visit our website www.greenmountaincamp.com to pay entire fee with PayPal. Or, send a $100 non-refundable

More information

CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017

CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017 CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017 Registration Deadlines Return Campers: Aug 1st New Campers: September 11th (Please use only black or blue ink and complete all information) Camper

More information

2019 Coulee Kids Summer Camp Registration Form

2019 Coulee Kids Summer Camp Registration Form 2019 Coulee Kids Summer Camp Registration Form Single Week: $170 Multiple Weeks/LWC Members/Past Campers: $160/week Multiple Campers 2+: $150/week Monday-Friday 8:30am-3:30pm (Early drop-off & late pick-up

More information

YMCA CAMP PINEWOOD 2014 Summer Camp Registration

YMCA CAMP PINEWOOD 2014 Summer Camp Registration YMCA CAMP PINEWOOD 2014 Summer Camp Registration Send completed form to 4230 Obenauf Road, Twin Lake, MI 49457 Fax to 231.821.0487 Email to mmccarthy@ymcachicago.org Call our office at 231.821.2421 with

More information

American Indian/Alaskan Native Black or African American Hispanic/Latino Asian or Pacific Islander Caucasian/White Mix Other

American Indian/Alaskan Native Black or African American Hispanic/Latino Asian or Pacific Islander Caucasian/White Mix Other For Official Use Only: Branch: Camp Site: Camp Group: CHILD S FIRST & LAST NAME ADDRESS (Street Address, Apt#, City, Zip Code) DATE OF BIRTH (Month/Day/Year) CHILD S DISMISSAL [ ] BE PICKED UP [ ]WALK

More information

SUMMER AT THE YMCA 2019 Health History Form

SUMMER AT THE YMCA 2019 Health History Form SUMMER AT THE YMCA 2019 Health History Form This form must be filled out completely, signed by the camper s parent/guardian, and returned with requested documentation to the camp office or YMCA Branch

More information

Forms A-C must be completed and sent to the Camp Floyd Rogers office and postmarked by June 1 st. Camp Floyd Rogers PO BOX Omaha, NE 68154

Forms A-C must be completed and sent to the Camp Floyd Rogers office and postmarked by June 1 st. Camp Floyd Rogers PO BOX Omaha, NE 68154 Forms A-C must be completed and sent to the Camp Floyd Rogers office and postmarked by June 1 st. Camp Floyd Rogers PO BOX 541058 Omaha, NE 68154 NOTE! The forms typically require $.70 postage in a standard

More information

Application Check List

Application Check List Criminal Justice Camp 2019 Entry Deadline for all camps: March 29, 2019 (Applications MUST be Postmarked by this date.) Session I: June 9-13 Session II: June 23-27 Session III: July 7-11 Session IV: July

More information

Dear Camper and Family:

Dear Camper and Family: Dear Camper and Family: We are excited about this year s Growing Together Day Camp, Monday June 20 through Friday June 24 and hope that you will join us for a week of fun and adventure at Camp Tyler. CAMP

More information

Camp Vincent Registration Form St. Vincent de Paul Camp, est. 1971

Camp Vincent Registration Form St. Vincent de Paul Camp, est. 1971 Camp Vincent Registration Form St. Vincent de Paul Camp, est. 1971 Please forward completed forms to: Camp Vincent, 80 King St. E, Chatham, ON N7M 3M8 P: 519-354-1885 F: 519-354-0859 register@campvincent.com

More information

Camper s Name Last First Middle Date of Birth Age Today s Date. Mailing Address City State Zip County Sex Race

Camper s Name Last First Middle Date of Birth Age Today s Date. Mailing Address City State Zip County Sex Race For Arc Use Only Application for 2018 Day Camp 546 S. Collett Street, Lima, Ohio 45805 Phone: 419-225-6285 Please fill out this application completely Any incomplete application will be returned to you

More information

Marianne Askew and Sally Joyce

Marianne Askew and Sally Joyce Dear Friend, Thank you for your interest in Camp Hope 2019. Camp Hope s mission is to create a healing environment for those living with cancer by fostering meaningful relationships with others through

More information

2017 Camper Application

2017 Camper Application 2017 Camper Application Dear Spearhead Family, Each summer season is special but summer 2017 marks a real milestone for Camp Spearhead. This summer Camp Spearhead turns 50! As we reflect on the heritage

More information

CAMP In Motion Adaptive Sports Camp for Children with Cerebral Palsy June June July July Camper Application

CAMP In Motion Adaptive Sports Camp for Children with Cerebral Palsy June June July July Camper Application CAMP In Motion Adaptive Sports Camp for Children with Cerebral Palsy June 12-16 June 19-23 July 10-14 July 17-21 Camper Application Name: Date of Birth: Male Female Address: City: State: Zip Code: Home

More information

Easter Seals. Tennessee Camp. Live Learn Work Play

Easter Seals. Tennessee Camp. Live Learn Work Play Easter Seals 2013 Tennessee Camp at Live Learn Work Play Since 1959, Easter Seals Tennessee has been committed to providing the highest quality recreation camping programs for youth with special needs.

More information

Camp Sun N Fun 2016 Application

Camp Sun N Fun 2016 Application Camp Sun N Fun 2016 Application CAMPER INFORMATION 1036 N. Tuckahoe Rd. Williamstown, NJ 08094 856-629-4502 P 856-875-1499 F camp@thearcgloucester.org First Name: Last Name: Nickname: Birthdate: Age: Gender:

More information

Nebraska-Iowa Kiwanis District Foundation

Nebraska-Iowa Kiwanis District Foundation Nebraska-Iowa Kiwanis District Foundation 2007 Camp OK Information and Forms This e-mail mailing is a way to save a lot of postage. Please print and use the forms provided here. February 1, 2007 Dear Kiwanian:

More information

CAMPER REGISTRATION FORM, SUMMER CAMP, 2015

CAMPER REGISTRATION FORM, SUMMER CAMP, 2015 CAMPER REGISTRATION FORM, SUMMER CAMP, 2015 FOR GRADES 3-12 (separate forms for Uno & Family Camps) Christian Church (Disciples of Christ) in Florida RETURN COMPLETED FORMS AND PAYMENT TO The Retreat at

More information

WHY. Search Blue Mash Golf Camp on YouTube to view fun videos of the past years of Summer Camp!

WHY. Search Blue Mash Golf Camp on YouTube to view fun videos of the past years of Summer Camp! WHY? The Areas Best Practice Facility- Blue Mash has the area s most immaculate and incredible practice facility featuring an all grass driving range tee. Your campers will receive instruction at our 10,000

More information

Day and Resident Camp

Day and Resident Camp Day and Resident Camp CAMPER NAME: BIRTHDAY: / / AGE AT CAMP: GENDER: M F ADDRESS: CITY: STATE: ZIP: PARENT/GUARDIAN S NAME: HOME/WORK/CELL PHONE: EMAIL: COUNTY: ETHNICITY: TRANSPORTATION/BUS SITES Car

More information

2018 Application. Easy Online Enrollment: Application valid 1/16/18. New Jr. Camp Pricing!

2018 Application. Easy Online Enrollment:  Application valid 1/16/18. New Jr. Camp Pricing! FAMILY INFORMATION 2018 Application Easy Online Enrollment: WWW.SLDC.COM Application valid 1/16/18 New Jr. Camp Pricing! 30 YEARS S L D C Celebrating Our 30th Anniversary! Family Name Home Phone Address

More information

GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form

GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form REGISTRATION OPENS JANUARY 3, 2019 A FULL PAYMENT OF $25 PER CAMPER PER DAY MUST BE MAILED WITH THIS COMPLETED REGISTRATION

More information

Registration Information and Fees

Registration Information and Fees South Shore Day Camp 2015 Registration Information and Fees Parent Information Name: Address: Town: Zip: Home Phone: Work Phone: Cell Phone: Parent s Email address: Parent s Email address: Please circle

More information

4460 Rex Lake Dr. Akron, OH gotcamp.org FAX SUMMER CAMP REGISTRATION. w June 4 9

4460 Rex Lake Dr. Akron, OH gotcamp.org FAX SUMMER CAMP REGISTRATION. w June 4 9 4460 Rex Lake Dr. Akron, OH 44319 330.644.4512 gotcamp.org FAX 330.644.1013 2017 OVERNIGHT CAMPS SUMMER CAMP REGISTRATION AKRON AREA YMCA 733-0114 REVISED FEB 2017 Camper s Name 2017 ROTARY CAMP DATES

More information

2013 BFA Jr. Balloonist Hot Air Balloon Camp Camp Registration Form Reno, Nevada

2013 BFA Jr. Balloonist Hot Air Balloon Camp Camp Registration Form Reno, Nevada 2013 BFA High Sierra Balloon Camp Western States Region Balloon Federation of America Jeff Haliczer, Director 15225 Pinion Dr. Reno, Nevada 89521-8841 Home Phone: (775)853-4109 Camp E-mail: Renoballooncamp@sbcglobal.net

More information

PLEASE FILL OUT ALL FORMS BEFORE SENDING IN: THE CAMPER PHYSICAL RECORD MUST BE FILLED OUT AND SIGNED BY A PHYSICIAN.

PLEASE FILL OUT ALL FORMS BEFORE SENDING IN: THE CAMPER PHYSICAL RECORD MUST BE FILLED OUT AND SIGNED BY A PHYSICIAN. Dear Friend of Camp Grace Bentley, Thank you for your interest in Camp Grace Bentley on the shores of Lake Huron in Burtchville, Michigan - just north of Port Huron. Enclosed you will find your registration

More information

ESO Summer Camp 2018

ESO Summer Camp 2018 ESO Summer Camp 2018 Dear Parent/Guardian: We are so glad you are interested in attending ESO Summer Camp at the Barber National Institute. Attached is the 2018 ESO summer camp Application Packet. WE WILL

More information

MIDWEST DIOCESE CAMP W. Grant Avenue - Third Lake, IL

MIDWEST DIOCESE CAMP W. Grant Avenue - Third Lake, IL MIDWEST DIOCESE CAMP 35240 W. Grant Avenue - Third Lake, IL 60046 midwestdiocesecamp@gmail.com Diocesan Kolo of Serbian Sisters Serbian Orthodox Diocese of New Gracanica Midwestern America 1. CAMPER INFORMATION

More information

FEE. (circle one) T-Shirt Size: XXL. Height: Weight: Phone Number: Relationship: $375 $400 $25. Non-CPI Participant. Transportation $25) $75 $10

FEE. (circle one) T-Shirt Size: XXL. Height: Weight: Phone Number: Relationship: $375 $400 $25. Non-CPI Participant. Transportation $25) $75 $10 Camp Partnerships Application 2018 This information is EXTREMELY important in helping to provide a safe and enjoyable time for each camper. Pleasee answer ALL questions completely and honestly. If ALL

More information

Sunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12!

Sunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12! Sunday, August 12 Saturday, August 18, 2018 We welcome campers entering grades 3 ~ 12! We expect every space to be filled up, so get your application in early! Deadline Date: June 30, 2018 After June 30th,

More information

UCP Camp Harkness Information NEW and REVISED for 2018!

UCP Camp Harkness Information NEW and REVISED for 2018! UCP Camp Harkness Information NEW and REVISED for 2018! Here you ll find all the information you need to know about Camp Harkness! Please use this as a reference because it will answer most of your questions

More information

South Shore Stars 2015 Summer Camp and Fall Enrollment

South Shore Stars 2015 Summer Camp and Fall Enrollment My child is in the grade, and attends After School Program. South Shore Stars 2015 Summer Camp and Fall Enrollment Child s Name(s) Parent s/guardian s Name Home Phone Work Phone Email Address Your child

More information

2018 Summer Camp Packet

2018 Summer Camp Packet WOR LD CL A S S M A S T E R ' S C H O N G 2018 Summer Camp Packet for registered campers Lancaster Location IMPORTANT: The last 3 pages of this packet must be filled out and turned in no later than June.

More information

Camp Celo. Medical Form Package Instructions:

Camp Celo. Medical Form Package Instructions: Camp Celo 775 Hannah Branch Road Burnsville, NC 28714 828-675-4323 Medical Form Package Instructions: These forms are required of all campers. Please complete and return by May 15. 1. Complete and sign

More information

2018 Summer Camp Registration Please select which camp your child(ren) will be attending

2018 Summer Camp Registration Please select which camp your child(ren) will be attending 1515 N. Galloway Avenue Mesquite, Texas 75150 972.216.6260 www.cityofmesquite.com 2018 Summer Camp Registration Please select which camp your child(ren) will be attending Kidz Kamp Sports Camp Camper Information

More information

Summer Camp at Wesley Gardens

Summer Camp at Wesley Gardens Summer Camp at Wesley Gardens An outreach of Wesley Monumental UMC Summer Camp at Wesley Gardens is a summer day camp experience for children who have completed kindergarten through fifth grade. We are

More information

YMCA Teens in Action Summer Camp Enrollment Form 2019

YMCA Teens in Action Summer Camp Enrollment Form 2019 June 10-14 June 17-21 June 24-28 July 1-5 July 8-12 July 15-19 July 22-26 July 29 - Aug. 2 Office Use only Date received: Extra Hands? (if so) Approval date: Weekly/Monthly Fee Entered into Daxko: YMCA

More information

Shepherds Camp 2011 Arrowhead Bible Camp Brackney, Pennsylvania

Shepherds Camp 2011 Arrowhead Bible Camp Brackney, Pennsylvania Shepherds Camp 2011 Arrowhead Bible Camp Brackney, Pennsylvania Application & Registration Form Office Use Only Rec d: Medical: Amount: # E: C: Camper Age M F DOB / / Address Phone ( ) - City State Zip

More information

July 6-8, 2017 Texas 4-H Conference Center

July 6-8, 2017 Texas 4-H Conference Center July 6-8, 2017 Texas 4-H Conference Center Thank you for your application to Mission Possible! To ensure we can adequately meet each campers needs, please complete this form and return either by mail to

More information

Application 2018 Located at Hawley Lake (Sierra Nevada Mountains)

Application 2018 Located at Hawley Lake (Sierra Nevada Mountains) Application 2018 Located at Hawley Lake (Sierra Nevada Mountains) Please Note: Hawley Lake is a program of the City of Sacramento, Youth Parks, & Community Enrichment Access Leisure section, in partnership

More information

YMCA CAMP LETTS 2018 OVERNIGHT CAMP General Information

YMCA CAMP LETTS 2018 OVERNIGHT CAMP General Information YMCA CAMP LETTS General Information Camper Last Name: Camper First Name: Session(s): Male: Female: Grade Entering in Fall: Birth / / Age at Camp: Street Address: Town/City: State and Zip: All individuals

More information

Seasonal Weekend and Summer Camps

Seasonal Weekend and Summer Camps CAMPER NAME: BIRTHDAY: / / AGE AT CAMP: GENDER: M F ADDRESS: CITY: STATE: ZIP: HOME/CELL PHONE: EMAIL: COUNTY: ETHNICITY: Custodial Parent/Guardian: Relation to camper: Home/Work/Cell Phone: Email: Address:

More information

YMCA of Glendale 2017 Summer Camp Fox Programs

YMCA of Glendale 2017 Summer Camp Fox Programs YMCA of Glendale 2017 Summer Camp Fox Programs ACTIVITIES INCLUDE: CAMP FOX, CATALINA ISLAND SWIMMING, KAYAKING, STANDUP PADDLE BOARDING, FISHING, DANCES, CAMPFIRES, ROPES COURSE, ARCHERY, VOLLEYBALL,

More information

July 12-15, Return to: Delta Pride c/o A-State Wesley P.O. Box 2775 State University, AR 72467

July 12-15, Return to: Delta Pride c/o A-State Wesley P.O. Box 2775 State University, AR 72467 July 12-15, 2017 Return to: Delta Pride c/o A-State Wesley P.O. Box 2775 State University, AR 72467 Important Numbers: Sam Meadors, Wesley Director 501.650.0565 Samantha Black, DP Director 479.629.4735

More information

Referral Information CHILDREN AGES 7-10 APPLICATIONS BY MAIL ONLY

Referral Information CHILDREN AGES 7-10 APPLICATIONS BY MAIL ONLY Referral Information CHILDREN AGES 7-10 APPLICATIONS BY MAIL ONLY Mission Statement The Stevenson Children s Camp is committed to providing a fun-filled, safe and memorable camp experience for children

More information

2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM

2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM 2017 VINS NATURE CAMP HEALTH AND EMERGENCY CARE FORM Instructions: Please return completed forms NO LATER than two weeks prior the start of camp. One set of forms per camper should be submitted per calendar

More information

Summer Camp at Wesley Gardens 2016 Registration

Summer Camp at Wesley Gardens 2016 Registration Summer Camp at Wesley Gardens 2016 Registration Camper Information (Please use a separate form for each camper) Camper s Name Goes by Camper s Age Grade Fall 2015 Male/Female Home Address City/State Zip

More information

Camper Application. Legal Guardian #1 Information. Legal Guardian #2 Information: Family Status: Mailing Address: Address: City: State: Zip:

Camper Application. Legal Guardian #1 Information. Legal Guardian #2 Information: Family Status: Mailing Address: Address: City: State: Zip: Camper Application Legal Guardian #1 Information First Name: Last Name: Relationship to Camper: Home Phone: Cell Phone: Work Phone: E-mail: Legal Guardian #2 Information: First Name: Last Name: Relationship

More information

Summer Art Camp 2015 Parent Orientation Guide

Summer Art Camp 2015 Parent Orientation Guide Summer Art Camp 2015 Parent Orientation Guide The following information is provided to answer most of the questions you may have as you prepare your camper to attend PAFA Art Camp. The leading counselor

More information

NEPHROLOGY MEDICAL FORM

NEPHROLOGY MEDICAL FORM You are invited to attend National Kidney Foundation of Arizona s Camp Kidney 2018! Camp Kidney will be held from Friday, October 26th, through Sunday, October 28th at Prescott Pines Camp in Prescott,

More information

CAMP ROSENBAUM. Youth Citizenship Camp c/o Home Forward 135 SW Ash St Portland, OR JULY 22 JULY 27, Dear Resident,

CAMP ROSENBAUM. Youth Citizenship Camp c/o Home Forward 135 SW Ash St Portland, OR JULY 22 JULY 27, Dear Resident, CAMP ROSENBAUM Youth Citizenship Camp c/o Home Forward 135 SW Ash St Portland, OR 97204 JULY 22 JULY 27, 2012 Dear Resident, Camp Rosenbaum invites you to send your child to our Youth Citizenship Camp

More information

Harvest Kidz Camp 2016

Harvest Kidz Camp 2016 DO NOT STAPLE USE PAPER CLIP PLEASE PRINT CLEARLY Camper s Information Last Name First Name Harvest Kidz Camp 2016 CAMPER REGISTRATION FORM Middle Social Security Number Date of Birth Age Gender Male Female

More information

Release Consent Form YMCA STORER CAMPS

Release Consent Form YMCA STORER CAMPS Release Consent Form YMCA STORER CAMPS Michigan Youth Camp Safety Laws require licensed camps to get authorization from parent/guardians for the release of their child to specific individuals. Please indicate

More information

NetXtreme Intro Sheet

NetXtreme Intro Sheet NETX YOUTH CAMP P.O. BOX 27 MAUD, TX 75567 For registrations after the deadline or other questions about registration call: 903.585.2569 fax: 903.585.9772 email: info@netxtreme.org www.netxtreme.org NetXtreme

More information

Y.E.S. Camp Youth Enjoying Summer Camp 2017 registration Form

Y.E.S. Camp Youth Enjoying Summer Camp 2017 registration Form Yes! It s that time again, New Bern Parks and Recreation is sponsoring our 2017 Y.E.S. Summer Camp session for children ages 5yrs- 14yrs. Registration fee is $20.00 for one child and $15.00 per additional

More information

CAMPER HEALTH HISTORY FORM 1

CAMPER HEALTH HISTORY FORM 1 CAMPER HEALTH HISTORY FORM 1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Mail this form to the address below

More information

Dates will attend camp: from to Month/Day/Year Month/Day/Year. Male Female Birth Date Age on arrival at camp Month/Day/Year

Dates will attend camp: from to Month/Day/Year Month/Day/Year. Male Female Birth Date Age on arrival at camp Month/Day/Year CAMPER HEALTH-CARE RECOMMENDATIONS by LICENSED MEDICAL PERSONNEL FORM 2 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp

More information

CAMPER HEALTH HISTORY FORM 1

CAMPER HEALTH HISTORY FORM 1 CAMPER HEALTH HISTORY FORM 1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Mail this form to the address below

More information

Camper Registration Form 6/10/14

Camper Registration Form 6/10/14 Camper Registration Form 6/10/14 Camper Name M or F Birthdate Mailing Address City State Zip Parent(s)/Guardian(s) Home Phone ( ) Cell Phone ( ) Work Phone ( ) Parent/Guardian Employer and Street Address

More information