CTB Sibling Camp Referral Form 2020
Kindred Matters is a non-profit 501 (c) (3) organization based in Oregon that has been working to shape strong family connections through Sibling camp programs, a foster/adoptive Family camp, and year round sibling enhancement events since 2001.

Due to COVID-19, Camp To Belong Oregon has been postponed to August 17-19 and has been converted to a day camp program.

Please answer these questions completely and thoroughly, the camper referral information is critical to the selection process.  A selection committee uses the information you provide to determine what campers we can accommodate. We need you to provide these details to help us understand the needs and behaviors of the child(ren). A referral form is needed FOR EACH INDIVIDUAL CHILD in the sibling group. Once you complete this for the first child, please start a new form for each additional child in the sibling group. If you are a provider making a referral, please make sure someone that knows the other siblings also puts in a referral. We can not consider a group for camp until all referrals are submitted for the entire group. By completing this referral, you agree to share all pertinent information with providers, parent, CASA, caseworker, etc so that all involved in the case of the child has the needed information. If at any time something changes with the child (needs/location/provider/etc)  you must notify Kindred Matters immediately with the new information. This process is the FIRST STEP. Once our committee reviews the referrals you will get an email with further details. If the sibling group is accepted into a camp session you will then get information on how to submit an official application. Do you have questions? If so, please email registerctb@gmail.com 
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What is the full legal name of the child you are referring to Camp To Belong? *
What is the birth date of the child? *
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Gender *
What CITY, and COUNTY does the child currently reside in. *
Has this child attended Camp To Belong in the past? *
What is the current custody status for the child? *
NAME, EMAIL, and PHONE # of person filling out this form, and your relation to the child. *
NAME, EMAIL, and PHONE number of DHS caseworker for this child. If child is adopted or in biological home but has siblings that are in DHS custody please include sibling's caseworker name if known. *
What is the full NAME, EMAIL address, and PHONE number for the person providing daily direct care to the child (parent, provider, care coordinator of residential facility, etc.) *
Please list the full  legal names of the other children that are part of this sibling group that will also be referred for camp this year (Make sure a separate referral is done for EACH child). *
Do the siblings visit each other now, and if so, how often? How do they get along with each other? *
Why do you think this sibling group would benefit from the camp experience? *
Tell us why the siblings are not currently living together. *
What are some of the child's favorite activities and/or hobbies? *
Does this child ever need 1:1 supervision? If so, please explain. *
Please check any that apply to the child. *
Required
How does this child get along with peers at school and youth in their current living situation? *
Does this child take any prescription medications or have any medical conditions that camp staff should be aware of? *
T-shirt size for Child *
Is there anything else that you feel like we should know about this child that wasn't covered in a previous question? *
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