Camper Application Part 1.
Thank you for your interest in Empowerment Camp. Before you apply please know preference will be given to:

-- Middle School students
--Students who attend New York City Public Schools
--Students committed to attending at one virtual info session with their counselor.
--Families that have reviewed our Safety Policy and commit testing their child 72 hrs. before the session begins (if necessary).

Applications will be accepted on a rolling basis. Complete this form and send in your $40 refundable bus deposit to secure your spot.

If you have any questions please feel free Josh Borkin via email (josh@stevescamp.org) or phone at
(646-241-0325).
TO BE FILLED OUT BY POTENTIAL PARTICIPANT
I plan to attend
Clear selection
Name *
First and last name
When is your birthday ?
MM
/
DD
/
YYYY
What is your email? *
What is your phone number? (if you have one) *
Which school do you attend? (please include full name ie. Brooklyn Preparatory Academy High school)
What grade are you currently in?
Clear selection
I consider myself
someone who likes to try new foods
someone who likes to eat the same things
Clear selection
I consider myself an
Introvert
Extrovert
Clear selection
I consider myself an
Indoor person
Outdoor person/nature lover
Clear selection
I consider myself
Talkative
Quiet
Clear selection
This year I have been absent
If you answered yes to the question above, is there a reason why you had more than 12 absences?
During Covid, I like to escape the world by
In what ways do you think Steve's Camp would benefit you?
Prompts: After a year of isolation, what do you look most forward to? Being outside? Around people? Away from Family?
What positive qualities do you think you will bring to Steve's Camp?
Prompts: What comes easy to you? Do you have any special skills or talents? What are you proud of?
TO BE FILLED OUT BY/ WITH A PARENT OR GUARDIAN
Parent/Guardian Name ( First, Last Name)
Parent/Guardian Email Address
Parent/Guardian Phone Number
What is your home address?
My Child receives special education services
If you checked yes, what accommodations would your child need while at camp.
In difficult situations my child tends to
Clear selection
Covid-19 has impacted all of us? How do you think it has impacted your child.
Clear selection
Does your child take any medication that they will bring to camp? Please list them here.
I understand and agree to my child summiting a health screening just prior to leaving Steve's Camp.
I understand and agree to my child reviving a COVID-19 test during their time a Steve's Camp.
I will pay my fully refundable $40 deposit
I affirm that I have truthfully answered every question truthfully and to the best of my ability?
A yes answer will be considered the same a writing a signature
Clear selection
Any final questions, comments, or anything else that you would like us to know?
What Happens Next
Once you have filled out this form and send a bus deposit your spot is formally secured. Over the next few months/weeks be on we will send you.

--A medical intake/dietary restrictions form to fill out.
-- A code of conduct contract to sign.
--A schedule of digital Q&A sessions and intro workshops (you will be required to attend 1).
--A packing list and bus schedule.

If you are no longer interested in attending Steve's Camp we ask that you reach out promptly. Likewise Steve's Camp reserves the right to release your spot if we are unable to reach you throughout the process. Thank you again. We are soooo excited for the summer!!!!!
Steve's Camp at Horizon Farms | 745 Westminster Road Brooklyn, NY 11230| (646) 241-0325| info@stevescamp.org
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