Camp Del-Haven Application 2018
Camp Del-Haven 887 NW 1901 Rd, Lone Jack, MO 64070 (816) 690-8465.

This application must be filled out by a parent or legal guardian.

You will receive an email confirmation once your application has been reviewed. A follow-up email and letter will be sent at a later time to confirm your child's admittance for our summer camp program and give you more specific details.

Email address *
First Name of Camper *
Your answer
Last Name of Camper *
Your answer
Name of Parent/Guardian (First and Last Name) *
Your answer
Parent Phone Number *
Your answer
Mailing Address (Include Apt. #) *
Your answer
City, State Zip Code *
Your answer
Age camper will be during camp session *
Birthday Day/Month/Birth Year *
MM
/
DD
/
YYYY
Select a camp date for your child - Check all dates that your child will be available to attend. (Only 9 year old campers are permitted to attend either age group session). *
Required
How will your child get to camp? *
Describe any physical handicaps or allergies that we should know about. *
Your answer
List any medication your child regularly takes. *
Your answer
Who is your child's physician? *
Your answer
When was your child last examined? *
Your answer
Do we have permission to distribute Children's Tylenol to your child for minor headaches or other minor aches and pains? *
In case of accident or illness the primary caregiver will be notified first. Please list names and phone numbers for two other people who can be contacted if the primary caregiver can't be reached. *
Your answer
Please list any persons other than yourself who are allowed to pick up your child. Children will not be released to unauthorized persons. *
Your answer
Waivers and Conditions: Pictures (no names) taken at camp may be used for advertisement purposes. (Examples: brochures, support newsletters, web pages, etc.) Camp Del-Haven is released from any liability in the event of an illness or accident that may occur to any camper. Each camper must be insured by their own provider. By agreeing below you give Camp Del-Haven the right to arrange for any special services or medical attention necessary for the camper’s welfare and good health. In such situations the camp will attempt to notify the parents/guardians as soon as possible. The parents/guardians are responsible for any expenses that may result from such services. I affirm that the information given is correct and accurate. I have carefully read the waivers and conditions of enrollment and agree to abide by them. *
Name of Parent / Legal Guardian *
Your answer
How did you hear about Camp Del-Haven? *
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