Camp Catch Up Camper Registration
Please fill out ONE form per camper. There are limited spots for campers this year, so sign up early! A family won’t be accepted until all siblings attending are signed up. Please communicate with sibling’s families to get them registered.

If you have any questions or concerns please reach out to Mona Tarin, Camp Catch-Up Director at mtarin@nebraskachildren.org or call/text at (402) 613-6357
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CAMPER INFORMATION
Camper First Name
Camper Last Name
Camper Birthdate
MM
/
DD
/
YYYY
Camper Preferred Name
Camper Age During Camp
Gender
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Preferred Pronouns
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Mailing Address
City
State
Zip
T-shirt Size
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Camper Race/Ethnicity
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Camper Strengths/Interests
CAMPER SUPPORT SYSTEM INFORMATION
Camper lives with:
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Caregiver Name(s):
Caregiver Phone
Caregiver Email
DHHS Worker Name (if applicable)
DHHS Worker Phone (if applicable)
DHHS Worker Email (if applicable)
Emergency Contact Name (in the event of an emergency and parent/caregiver cannot be reached.)
Emergency Contact Phone
Relationship to Camper
Camp Catch Up Information
Siblings Attending Camp With:
Which session will camper be attending? (Please select only ONE summer camp session)
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Person(s) authorized to pick up camper from camp or bus stop: (List as many as needed)
Camp Comeca, Cozad, NE Camp Transportation 
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Do you need transportation assistance to and from the Eastern Camp at Camp Solaris *
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