CLW Application 2020
Please fill out ONE form for EACH applicant. Thank you!

We accept campers aged 9-15 and counselors aged 15-18. Counselors aged 15 are considered but may remain campers until age 16.

CAMP BEGINS at 6pm Sunday, July 26th. Campers should arrive in camp no later than 6:45. Please DO NOT ARRIVE in camp before 5:45 – staff will be eating their dinner!

For counselors, camp starts Sunday, July 26th at 11am.

CAMP ENDS 3pm Friday, August 31st. Campers should be picked up no later than 3:45.
Email address *
Youth's First Name (and middle name if used): *
Youth's Last Name: *
Preferred name to go by at camp:
For which role is your child applying? *
Will you be applying for financial aid for camp this year? *
Cost for one youth is $200. Please know that we are operating with a limited scholarship budget and scholarships will be first-come-first serve until our limit is reached. The Diocese also has scholarships available: http://www.norcalepiscopal.org/camps-2020.
If the answer to the above question is yes, how much financial aid are you requesting?
Youth's Age on July 1, 2020: *
We accept youth ages 9 and up.
Youth's Preferred Gender: *
Youth's school grade in the Fall: *
Youth's Date of Birth: *
Youth's email address, if applicable:
Youth's cell phone number, if applicable:
Mailing address: *
City: *
State: *
Zip Code: *
Please *carefully* choose a tee-shirt sizing option. If you are not sure whether to select youth or adult, check online sizing guides: https://www.sizeguide.net/size-guide-children-size-chart.html *
T-shirt size *
Who will bring youth to camp (camp starts at 6pm on Sunday, July 26)? Please provide the full name. *
Who will take youth home from camp (camp ends at 3pm on Friday, July 31)? Please provide the full name. *
Parent and Contact Information
Please fill out as much as is applicable
Home phone number: *
Name of parent/legal guardian: *
Parent/guardian cell phone: *
Work phone number:
Parent/guardian email address #1: *
Name of second parent/legal guardian, if applicable:
Parent/guardian #2 cell phone:
Parent/guardian #2 work phone:
Parent/guardian #2 email address:
What year of Camp Living Waters will this be for your child? *
If you're new to Camp Living Waters, how did you hear about us?
Clear selection
If your child is new to CLW, would you like to request a tent partner?
Hobbies and Interests
Tell us a bit about your child's interests!
What are your child's interests/hobbies? *
My child's swimming skills are: *
Does your child attend a church? *
If you answered anything other than "no" in the above question, what church does your child attend, and in what city? (ex: Christ Church, Eureka)
Does your child attend a religious youth group? *
If you answered anything other than "no" in the above question, what youth group does your child attend, and in what city?
Health and Food Details
Please be as descriptive and detailed as possible. You may return to edit your answers later, if you would like.
What dietary needs does your child have? *
Please list any food allergies your child has: *
If none, put "N/A"
Please list any medication allergies your child has: *
If none, put "N/A"
Other allergies:
Does your child have any medical concerns? *
(i.e. asthma) If none, put "N/A"
Please list the medications your child is currently taking and instructions for dosage: *
If none, put "N/A." ALL prescription medication must be given to the Camp Medic upon arrival in camp.
Date of last tetanus shot: *
Has the youth been MMR vaccinated? (Measles, mumps, rubella). Please include the date if known.
If you have concerns about this question, please contact us at: CLWHumboldt@gmail.com.
Date of last physical exam: *
Child's Physician: *
Physician's phone number: *
Medical Insurance Provider: *
Group ID Number: *
Emergency contact name (not parents): *
Emergency contact phone number(s) *
Please list as many as you are able
Child's relationship to emergency contact: *
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