Camp Kindle Day Camp Pre-Registration Form
Dear Parents, Guardians and Organizations:
We hope this finds you well. This summer, Project Kindle, a locally run non-profit organization, will be offering a unique day camp program for children with special needs, chronic illnesses, and other life challenges- Camp Kindle Day Camp. This camp will offer a medically and emotionally supportive environment for each of its participants. Each participant will be paired with a counselor that they will work with in a one-on-one capacity throughout the week of camp. This program will help each child find positive meaning in their life by making friends, having fun, and sharing hopes with others confronting similar circumstances. Additionally, this camp will help primary caregivers by providing respite and necessary time for themselves. This summer day camp experience will emphasize teaching children life skills through math, science, music, and art. We believe that every camper will learn and grow through this program. Eva Payne established Project Kindle in 1998, and the organization has been running various summer camp programs for 22 years. For questions, please contact Minnow at
glorimar@projectkindle.org
.
Eligibility Criteria:
1. All youth must be between the ages of 5 and 12 on the first day of camp.
2. All youth must have a special need, disability, chronic illness, or other life threatening disease, and be medically cleared to participate in day camp activities.
3. Campers should reside in the Santa Clarita Valley, or within driving distance with a mode of transportation to and from the day camp location.
4. Campers must not have an aggressive background towards themselves or others. If camper poses a physical danger to himself or herself, other campers, of staff members at Camp Kindle Day Camp, he or she may be excused from the camping program at the discretion of the Camp Kindle Administration.
Forms and Registration:
Pre-Registration forms will continue to be accepted through June 1st. All applicants will remain confidential. We will be accepting up to 40 youth this summer. Once the Pre-Registration Form is sent in, reviewed and accepted, a confirmation packet will be sent out with additional release and medical forms.
If you have any questions about our program or would like more information, please contact us. Feel free to share the link to this form with any family/youth who would benefit from this program.
Thank You,
Camp Kindle Leadership Team
* Required
Email
*
Your email
Camper Application Info
Please complete one form per applicant.
Pre-registration is open until session fills.
June 15-19 (Mon-Fri) - Camp Kindle Day Camp
First name
*
Your answer
Last Name
*
Your answer
Name child goes by
Your answer
Date of Birth (MM/DD/YYYY)
*
Your answer
Current Grade In School
*
Your answer
Gender
*
Male
Female
Please describe applicant's special needs.
This includes any and all medical and/or psychological diagnosis.
Your answer
Any Allergies?
*
Yes
No
If yes, please explain
Your answer
Any Dietary Restrictions?
*
Yes
No
If yes, please explain
Your answer
Any Activity Restrictions?
*
Yes
No
If yes, please explain
Your answer
Approximate Weight
*
If unknown, please estimate in pounds.
Your answer
T-Shirt Size
*
Child Small (6-8)
Child Medium (10-12)
Child Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Is applicant applying to any other summer camps this year?
*
Yes
No
If yes, what camp(s)?
Your answer
Please describe any medical needs, physical or mental challenges of the youth.
*
Your answer
Does your child have an Individualized Education Plan (IEP)?
*
Yes
No
If yes, what is your child's educational disability?
*
Your answer
Parent or Guardian Contact Information
First and Last Name
*
Your answer
Relationship to Applicant
*
Your answer
Street Address
*
Your answer
Street Address
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Phone Number
*
Your answer
Alternate Phone Number
*
Your answer
Email Address
*
Your answer
How did you hear about Camp Kindle Day Camp?
Your answer
If someone other than the child’s parent/guardian has completed this form, please complete this section:
First and Last Name
Your answer
Relationship to Applicant
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone Number
Your answer
Alternate Phone Number
Your answer
Email Address
Your answer
Does this child live with you?
Yes
No
Clear selection
If no, who does the child live with?
Your answer
If the camper application is accepted a detailed medical profile and physical will be required to assist our staff in meeting the needs of each camper.
NOTE: All Information provided will be kept confidential in accordance with 381(e)(5) of the Public Health Service Act. 42 U.S.C. 247 c(e)(5). Project Kindle is a 501 c 3 organization and is independently operated
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