Register for Camp Braveheart

Camper Information
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Gender
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Date of Birth
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This data is collected only for the purpose of obtaining grants and funding for camp.
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My child is applying for

Parent/Guardian Information

(with whom child lives)

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In Case of Emergency

We will always contact the parent/guardian first if there is an emergency. Please provide us with an alternative contact in the event that we are unable to reach you.

other than parent/guardian
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Camper Personal Information

Complete questions thoroughly. The more we know about your child, the better prepared we can be for the camp week.

1. Has your child been to Camp Braveheart before?
2. Has your child been to another overnight camp?
3. Is your child able to function at his/her age level?
4. Does your child have any developmental delays or chromosome disorders (e.g., Trisomy 21/ Downs Syndrome)?
5. Does your child have any special bedtime or sleep habits?
6. Does your child have any fears?
7. Does your child have any physical limitations?


check all that apply
8. Does your child have any special care needs?








check all that apply
9. Does your child need help with personal hygiene activities?





check all that apply
11. In the past 12 months, has the camper had any serious illness or injury requiring surgery or hospitalization (including transplant related)?
12. Does your child have any behaviors that we should know about? (i.e., trouble at school, fighting, following directions, problems with authority, etc.)
Does your child have any special dietary needs?

Physician Information