Camp Horizon Camper Referral Form
Please use this form to refer a child to Camp Horizon's summer camp for abused/neglected children. Campers must be between 8-10 years old and currently in state custody (DFCS). After receiving the referral, we will reach out to the appropriate contacts to determine if the camper is eligible to attend our summer camp.

PLEASE UNDERSTAND THAT WE HAVE LIMITED AVAILABILITY. WE CANNOT ACCEPT ALL NEW REFERRALS.
Date of Referral *
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Person Making the Referral *
Your answer
Relationship to the Child *
Your answer
Child's Full Name *
Your answer
Child's Date of Birth *
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DD
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YYYY
What county is the child in custody of? *
Case Manager Full Name *
Your answer
Case Manager Phone Number *
Your answer
Case Manager E-Mail Address *
Your answer
Why do you believe this child should attend Camp Horizon? Please provide as much information as you are comfortable sharing. *
Your answer
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This form was created inside of Camp Horizon Inc. Report Abuse