Camper Application
Steve’s Camp at Horizon Farms empowers young people to develop healthy bodies, hearts, and minds. Our summer camp program is the cornerstone of our work with youth. At camp, participants recruited from underserved New York City high schools spend twelve days living on a beautiful working farm in the Catskills – free of charge. Campers learn to create healthy living environments, develop positive leadership and collaboration skills, and striving to live self-reliant lives.
Over the course of a 2 week session SCHF aims to mix healthy living and leadership development with a heavy dose of fun. Campers, many of whom have never ventured out of New York City, have the opportunity to explore our 100 acre campus in the heart of the Catskills - just two hours northwest of NYC - and participate in a variety of interests both new and old.
Application deadline is April 30th 2020
* Required
Name
*
First and last name
Your answer
When is your birthday ?
MM
/
DD
/
YYYY
What is your email?
*
Your answer
What is your phone number?
*
Your answer
What is your home address?
Your answer
Which school do you attend? (please include full name ie. Brooklyn Preparatory Academy High school)
Your answer
What grade are you currently in?
7th
8th
9th
10th
11th
Clear selection
Which session are you available to attend camp?
*
Please select one option.
Boys Session 1 (June 28 - July 9)(Spots available for this session wait-list only)
Boys Session 2 (July 12 - July 23)
Girls Session 3 (July 26 - August 6)
Girls Session 4 (August 9 - August 20) (Spots available for this session wait-list only)
Required
Parent/Guardian Name ( First, Last Name)
Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian Phone Number
Your answer
Emergency Contact ( First, Last Name and Phone Number)
Your answer
Do you have any allergies (to medicine, food, animals, insects, grass etc)?
Your answer
Please select your dietary restrictions, if any.
Your answer
Are there any restrictions on activities your child can engage in at camp? If so, please list them here: (ie. Can not engage in rigorous physical activity more than 30 minutes etc)
Your answer
Please briefly provide context to your child's health history (if not listed, please select other and describe below)
Has abnormal menstrual history
Has asthma
Has diabetes
Has high foot arch
Has flat feet
Wears glasses, contacts or protective eye wear
Has chronic or recurring illness
Has frequent headaches
Has had surgery
Has motion sickness
Becomes dizzy during or after exercise
Has chest pain during or after exercise
Has ADHD
Seeks professional mental health services
None of the above
Other:
Clear selection
If you checked any of the responses above, please explain here
Your answer
Does your child take any medication that they will bring to camp? Please list them here.
Your answer
If you'd like us to send the Medical Authorization directly to your family physician, please list their name, email address and/or fax number below.
Your answer
I understand and agree to Steve's Camp terms and conditions for acceptance.
Yes
No
I agree to fully participate and engage in all Steve's Camp activities and programming
Yes
No
Clear selection
I will pay my fully refundable $40 deposit
Check: mail to Steve's Camp, 252 W 37th Street, Suite 4000, New York, NY 10018
Money order: mail to Steve's Camp, 252 W 37th Street, Suite 4000, New York, NY 10018
Cashapp: $schfnyc
I am requesting waiver (*This request implies that you will have to attend the camp session)
Other:
Any final questions, comments, or anything else that you would like us to know?
Your answer
Please briefly explain how you learned of Steve’s Camp.
Your answer
Any final questions, comments, or anything else that you would like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Steve's Camp at Horizon Farms, Inc..
Report Abuse
Forms
