Caregiver Interest Form
We're excited that your child is interested in attending Camp HOPE America-Arkansas 2020! Please answer the questions below thoughtfully and honestly so that we can know a little bit more about your child. Due to limited space, please note that we are not able to guarantee attendance for any child.

We will soon schedule a Meet and Greet conversation where we can learn more about your child and how they might benefit from participating in Camp HOPE America-Arkansas. Thank you for your understanding!
Email address *
Your Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
What is your relationship to the child? *
Your answer
What is the child's name and birthdate?
Your answer
What grade will your child be entering in the fall of 2020?
Your answer
Has your child attended overnight camp in the past? If yes, when?
Your answer
Are you currently receiving services (therapy, job training, childcare, etc.)?
Is your child currently receiving services (therapy, childcare, etc.)?
Does your child have any behavioral issues that might interfere with a week at Camp HOPE America-Arkansas?
Your answer
What do you think your child might gain from attending Camp HOPE America-Arkansas?
Your answer
What does your child do when they are angry or experience conflict?
Your answer
Has your child processed their trauma with a professional? If yes, please provide the name and phone number of their therapist/social worker?
Your answer
What are some potential challenges that might arise if this camper attends camp?
Your answer
Is there anything else that would be helpful for us to know in advance?
Your answer
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