2018 Camp Weekaneatit- Initial Camper Application
SPACE IS LIMITED....FIRST COME, FIRST SERVE---ALL APPLICATIONS MUST BE COMPLETED BY MARCH 15, 2018

DATES FOR Camp: May 27 - June 1, 2018 at Camp Dream in Warm Springs, GA

STEPS TO REGISTER:

1. Please complete this attendee application and submit. AT THE END OF THIS APPLICATION BELOW, MAKE SURE TO PRESS SUBMIT. IF YOU DO NOT GET A THANK YOU, THEN YOUR FORM HAS NOT BEEN SUBMITTED. LOOK DOWN THE FORM AGAIN AND ANSWER ANY QUESTIONS HIGHLIGHTED IN RED THAT WERE REQUIRED QUESTIONS. THEN PRESS SUBMIT AGAIN!

2. Submit camper fee to reserve your spot at Camp Weekaneatit via:
• PAYPAL: GO TO: www.GlutenFreeCamp.org PUT YOUR child's NAME IN THE MESSAGE LINE. There will be a fee added to use PayPal.
• PAYPAL PAYMENT PLAN: If you need a payment plan, you may still go through our PayPal link and apply through that link www.GlutenFreeCamp.org for a payment plan. Once you have made that arrangement, we will receive notice and consider you paid, for our purposes. Your payment plan agreement is between you and PayPal.
• CHECK: you may mail your check, made payable to: Georgia Celiac Foundation WITH YOUR CAMPER'S NAME IN THE REFERENCE LINE and mail to:

Camp Weekaneatit, 1358 Binder Place NE, Unit A, Atlanta GA 30307


3. Once we receive your application and payment, our medical committee will review and you will be notified when you have been accepted to this years’ camp. You must have your registration fee in before your application will be reviewed and your attendee space reserved. Space is limited, so please be timely.

4. Once your receive acceptance notification, you will be directed to complete additional required forms and information. Some forms will require medical provider signatures—SO PLEASE PLAN APPOINTMENTS ACCORDINGLY SO YOU CAN GET US FORMS ON TIME. Signatures will be required from:
• A doctor that gives medical clearance for your child to attend
• A therapist-- if your child has seen one in the past year

ALL ADDITIONAL NECESSARY FORMS MUST BE COMPLETED AND TURNED IN NO LATER THAN MAY 1, 2017 OR YOUR SPACE WILL BE GIVEN TO OTHERS ON THE WAIT LIST WITH NO REFUND.

5. PLEASE NOTE. NEW. You are required to submit (upload) your camper's up to date immunization records in the final inquiry in section one below. If you have issue uploading--you MUST email the record the same day as you submit this form, with your camper's name in the subject line to: CampWeekaneatit@gmail.com

6. For any questions, please contact us at: CampWeekaneatit@gmail.com

Camper's Name *
Preferred Name for Name Tag
Date of Birth *
Grade *
Please indicate current grade in school.
Age attendee will be AT the camp this summer (BY MAY 26, 2018) *
Gender *
FORM YOU WILL BE SUBMITTING YOUR FEE *
If submitting payment or payment plan through PayPal, please indicate here the name on credit card used. If paying via check- Mail your check the same day you are submitting this application (with your camper name on the reference line) *
this is to ensure that your payment goes toward your child
Parent/Guardian Name *
Relationship to Camper
Street Address
State
City
Zip Code
Primary Phone *
Secondary Phone
Other Phone
Email Address *
Note: All correspondence will be communicated via email, so please check your email for updates!
Secondary Email Address
Please complete only if you want correspondence sent to this account.
Emergency Contact Name *
Person to be contacted in case of emergency if parent/guardian cannot be reached.
Relationship to Attendee
Emergency Contact Primary Phone *
Emergency Contact Secondary Phone
Emergency Contact Other Phone
Insurance Company Name *
Phone *
Address
City
State
Zip Code
County
Policy Number
Is applicant: Diagnosed Celiac/Gluten Intolerant OR the sibling of a diagnosed celiac/gluten intolerant? *
If sibling/ please indicate your siblings name that is attending camp who has been diagnosed with celiac/gluten intolerance *
Date of Celiac/ Gluten Intolerance diagnosis by a medical provider
if sibling indicate "sibling"
Diagnosing Physician's Name, Address and Phone number *
if sibling indicate "sibling"
Briefly describe your reaction to gluten *
if sibling indicate "sibling"
Dietary Restrictions *
Note: We will do our best to accommodate additional dietary restrictions other than GF. However, please only list those that are MEDICALLY necessary for your child
Medication Allergies *
List all known. Describe reaction and management of the reaction.
Food Allergies *
List all known. Describe reaction and management of the reaction.
Other Allergies. *
List all known. Include insect stings, hay fever, asthma, etc. Describe reaction and management of the reaction.
Has your child/Does your child.... *
If yes, check the box.
Required
Which of the following has your child had? *
Please note: If you child has been exposed to any communicable disease, particularly chicken pox, measles, or mumps, 1 to 3 weeks prior to camp, please contact us as soon as possible.
Required
IMPORTANT REQUIREMENT-all campers are REQUIRED to have proof of the below listed vaccinations. You must submit your child's immunization records --THROUGH THIS FILE UPLOAD. ALL CAMPERS ARE REQUIRED TO BE UP TO DATE ON THE FOLLOWING--IF THEY DO NOT HAVE EACH OF THESE --YOU MUST ARRANGE TO GET THE IMMUNIZATION AND SUBMIT THE FORM WITH ALL OF THESE COMPLETED: MMR, Varicella, DPT, DT Tdap, Hep B, Polio, and MCV4 (meningitis) for those 11 years - 21 years old. IF YOU ARE MISSING SOME. YOU CAN SUBMIT WHAT YOU HAVE WITH AN EMAIL TO US STATING THAT YOU WILL BE GETTING THE MISSING ONES AND THAT YOU WILL RE SEND ONCE YOU GET THEM. *
Required
Insurance Card UPLOAD *
Required
If no, please explain.
Medication
The medical staff will store and administer any medications needed during the camp week. PLEASE SEND ALL MEDICATIONS TO CAMP WITH YOUR CHILD IN THEIR ORIGINAL CONTAINER WITH WRITTEN INSTRUCTIONS. It is expected that each family will supply in advance any routine medications needed. Specific instructions on how to send medications and the medication check-in process will be sent to you closer to camp.
Check one of the following boxes. *
List each medication name, dosage, and frequency.
Name of Primary Care Physician *
Primary Care Physican Phone Number *
Name of GI *
GI's Phone Number *
Does your child use any special equipment such as a walker, crutches, wheelchair, or prosthesis? Please explain.
Please list any physical restrictions or activity limitations (i.e. no swimming, no prolonged sun exposure, no competitive sports, sight or hearing loss, etc.).
Is there anything we should know about your child that will make his/her adjustment smoother?
Is your child able to function at his or her age level? Please describe.
Describe any bedtime or sleep habits (eg. sleeps with parent, toys, talks/walks/ in sleep, etc.).
Does your child have any serious fears? Please describe.
Please indicate any further information about your child's medical and/or emotional needs that you feel we should know. Please include if your child sees a psychiatrist or psychologist regularly.
Camper's T-shirt Size
If your child would like to share a bunk room with a friend, please list by name.
REQUESTS WILL ONLY BE CONSIDERED FOR CAMPERS IN THE SAME AGE RANGE and will be assigned check-in. NOT GUARANTEED!
Where did you hear about Camp Weekaneatit?
Have you attended Camp Weekaneatit previously
If yes, how many years
Do you plan to attend other summer camp programs this coming summer?
If yes, please list along with the dates
If you would like to be considered for a limited number of scholarships, please provide an explanation of need.
You MUST indicate below, how much you can afford toward the camper fee AND why you are requesting financial assistance. You will not be required to pay anything now. We will get back to you after 3/15/18. Go to our site for more info
BE SURE TO CLICK SUBMIT!!!!!
MAKE SURE TO PRESS SUBMIT. THEN, IF YOU DO NOT GET A THANK YOU, YOUR FORM HAS NOT BEEN SUBMITTED. LOOK DOWN THE FORM AGAIN AND ANSWER ANY QUESTIONS HIGHLIGHTED IN RED THAT WERE REQUIRED QUESTIONS.
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