BASE Camp - Event Sign Up
This form will sign you up for the BASE Camp Overnight and special events. Please enter in all the information of the patient and/or siblings who will be attending. Every month please visit here to sign up for the latest BASE Camp Event. Any questions, please feel free to reach Cindy at cindy@basecamp.org or 407-408-0467.
Are you signed up with BASE Camp?
If you are a new family, we will be sending you information on how to register with BASE Camp. All children must be signed up with BASE Camp to attend.
Email Address:
We will be communicating via E-Mail for all last minute details and information on the camp. Please but the best email address to reach you here.
Your answer
Contact Number:
Best number to reach you on the night of the overnight camp.
Your answer
Patient First Name:
Your answer
Patient Last Name:
Your answer
Date of Birth:
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Sibling First Name:
Your answer
Sibling Last Name:
Your answer
Date of Birth:
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YYYY
Sibling First Name:
Your answer
Sibling Last Name:
Your answer
Date of Birth:
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YYYY
Sibling First Name:
Your answer
Sibling Last Name:
Your answer
Date of Birth:
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YYYY
Sibling First Name:
Your answer
Sibling Last Name:
Your answer
Date of Birth:
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YYYY
Sibling First Name:
Your answer
Sibling Last Name:
Your answer
Date of Birth:
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Additional Attendees Information:
All additional guest must be approved by BASE Camp prior to attending. Please put first name, last name, DOB and emergency contact for any additional attendees here.
Your answer
Chaperone Notes:
Please list any important notes for chaperones on children attending.
Your answer
I am signing up for:
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