Your Camper's Name
*
First Name
Last Name
What do they prefer to be called (first name)?
Which camp are they attending?
*
Choose One
California
Virginia
Colorado
Your Name
*
First Name
Last Name
Relationship to the camper:
*
Your Email
*
Your Phone
*
(###)
###
####
What would you like for us to tell your camper’s counselor about him/her?
*
What insights do you have that will help us in working with your child at camp this summer?
Are there any personal factors that may affect your child’s adjustment to camp? Examples may include a recent change in the family, a separation or death, a recent move, a school event, ADD or ADHD, health or dietary issues.
Most campers do not make roommate requests. Though we encourage campers to meet new friends by limiting roommate requests, we will try to honor a request if the campers are similar in age and the request is made by a parent or guardian of each child at least three weeks prior to the start of the session. We reserve the right to make final placement decisions. NO changes can be made on opening day or thereafter. I would like to request to be in the same room with the following camper (be sure and contact your request to make sure it is mutual!):
Please do not place my camper with the following camper:
If your camper will take daily medication(s) while at camp, please list the name of the medication, the reason for taking it, and when it is to be given
Has your camper ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?
Choose One
NO
YES
Has your camper ever been treated for emotional or behavioral difficulties or an eating disorder?
Choose One
NO
YES
Has your camper during the past 12 months, seen a professional to address mental/emotional health concerns?
Choose One
NO
YES
Please explain “Yes” answers in the space below. The camp may contact you for additional information.
What have we forgotten to ask? Please provide in the space below any additional information about the camper’s health that you think important or that may affect the camper’s ability to fully participate in the camp program.