NF Camp 2019
Welcome! We are so excited to host your Hero at NF Camp this year.

After you fill this form out there will be additional informational sheets and a physical form to download and fill out. Please make your appointment with your doctor as soon as possible to ensure forms are returned before June 20.

Email address *
Please check which week you are applying for. *
Week 1 - ages 18-25 / Week 2 - ages12-17 If you feel your camper may have a specific circumstance, please select other. We can call you directly to discuss further.
Camper First Name *
Your answer
Camper Last Name *
Your answer
Camper Age *
Please put the age of your camper as they will be on the first day of camp.
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School Grade
If applicable.
Your answer
Gender *
Neurofibromatosis Type *
Camper Email Address
Your answer
Camper Cell *
This is very important for the airport.
Your answer
Camper T-Shirt Size *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country *
Your answer
Name of Parent / Guardian *
Your answer
Parent / Guardian Email Address *
Your answer
Priority Phone Number *
Your answer
Secondary Phone Number *
Your answer
Emergency Contact 1 Name and Relationship *
Your answer
Emergency Contact 1 Phone Number *
Your answer
Emergency Contact 2 Name and Relationship *
Your answer
Emergency Contact 2 Phone Number *
Your answer
New or Returning Camper *
About Your Camper *
please give details include specific medical issues, social adaptability, learning disabilities, etc.
Your answer
Dietary Restrictions *
Please let us know if there are any allergies or dietary restrictions we should be aware of.
Your answer
Media / Publicity Release *
I hereby consent that the videotapes, photographs, and/or motion picture film in which I/ my camper appears, and/or audio recordings made of my /camper's voice, may be used by the Children’s Tumor Foundation to further the work of the Children’s Tumor Foundation. I consent that these audio/visual materials shall be the property of the Children’s Tumor Foundation, which has the right to duplicate, reproduce, publish in print or electronically, and make use of these materials free and clear of any claim whatsoever on my part.These materials will remain in the active files for the life of this project and/or five years, which ever is longer. At that time, the audio/visual materials will be catalogued and filed within the historical archives of the Children’s Tumor Foundation for possible use to illustrate the history of the Children’s Tumor Foundation.
Required
Waiver / Medical Release *
I consider my/self /son/daughter capable of taking part in the Children’s Tumor Foundation Summer Camp activities and I agree to his/her doing so. The information on this form is true and correct to the best of my knowledge. I hereby grant permission for CTF staff and Camp Kostopulos staff to provide first aid. I grant Camp Kostopulos nursing staff permission to administer prescribed and over-the-counter medications and other necessary medical treatment. I also grant permission for Camp Kostopulos administrative staff to administer prescribed and over-the-counter medications and other necessary medical treatment if the nurse is not available. In the event of illness or accident where I cannot be reached, I hereby give my permission for any first aid or emergency treatment for the above named camper by the staff of CTF, Camp Kostopulos, or an accredited hospital/clinic if deemed necessary by such staff. In regards to health care at Camp Kostopulos (the “Camp”), the Camp is not a medical facility. The Camp will provide basic health care generally accepted in the camping industry. However, if your child needs greater assistance, please provide that level of care through your own resources. In the event of an emergency, I hereby give my permission for the Camper to receive first aid treatment and if necessary hospitalization, anesthesia, injection, surgery and any and all other medically-related treatment. I hereby affirm that I am the parent or legal guardian of applied for camper. Furthermore, I affirm that the information contained herein is correct and complete. The Camper has my permission to engage in all camp-sponsored activities, including, but not limited to: horseback riding, swimming, boating, fishing, hiking, camping, sports, games, arts and crafts, dances, challenge ropes course and field trips off camp property (the “Activity List”), except as previously identified by me on the Participant Information Sheet available from the Camp. I have shared the Activity List with the Camper’s doctor, and I acknowledge that the activities on the Activity List can be inherently dangerous. By signing below, I assume all risk and responsibility and voluntarily allow the Camper to participate in the activities cited on the Activity List and all other regular Camp activities. On behalf of the Camper, myself, all relatives of the Camper, and all successors and assigns, I hereby release from any and all liability and agree to indemnify, defend, hold harmless and covenant not to sue or bring any other action against the Camp, the Children’s Tumor Foundation (the “CTF”) and each of their successors and assigns and the officers, directors, members, shareholders, employees, volunteers and contributors of the Camp and the CTF and each of their successors and assigns arising from accident and/or injury resulting from participation in the activities cited on the Activity List and relating in any way, directly or indirectly, to the Camper’s attendance at the Camp or activities to and from the Camp. * I understand that if he/she acts in a manner that Staff at Camp Kostopulos finds harmful to self or others, I will be responsible for picking the participant up and taking them home or will be responsible for the cost to remove the participant from Camp until he/she can be taken home.I understand that the Children’s Tumor Foundation and Camp Kostopulos are not responsible for articles that are lost or stolen while the camper attends camp. I understand that while at camp that he/she may be responsible for damage done to Camp or personal property.
Required
Camp Tuition of $650 *
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