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
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 *
Last Name *
Name child goes by
Date of Birth (MM/DD/YYYY) *
Current Grade In School *
Gender *
Please describe applicant's special needs.
This includes any and all medical and/or psychological diagnosis.
Any Allergies? *
If yes, please explain
Any Dietary Restrictions? *
If yes, please explain
Any Activity Restrictions? *
If yes, please explain
Approximate Weight *
If unknown, please estimate in pounds.
T-Shirt Size *
Is applicant applying to any other summer camps this year? *
If yes, what camp(s)?
Please describe any medical needs, physical or mental challenges of the youth. *
Does your child have an Individualized Education Plan (IEP)? *
If yes, what is your child's educational disability? *
Parent or Guardian Contact Information
First and Last Name *
Relationship to Applicant *
Street Address *
Street Address
City *
State *
Zip *
Phone Number *
Alternate Phone Number *
Email Address *
How did you hear about Camp Kindle Day Camp?
If someone other than the child’s parent/guardian has completed this form, please complete this section:
First and Last Name
Relationship to Applicant
Street Address
City
State
Zip
Phone Number
Alternate Phone Number
Email Address
Does this child live with you?
Clear selection
If no, who does the child live with?
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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