Walton Winter Weekend 2019
Dates for this camp are February 8-10, 2019 in Rutledge, Georgia at Camp Twin Lakes. For children ages 6-18 with a physical disability and their families*.
Every family will have their own cabin! *Each child may bring up to 3 family members with them. Once you have been accepted, we ask for a $25 registration fee (per family). You can pay this at www.waltonfoundation.net/donatenow and select "Walton Winter Weekend" as the fund designation.
Camper Name: *
Please note questions with "Camper" are referring to the child with a physical disability. Siblings and parents are referred to as "family"
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Camper Date of birth: *
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Camper Current grade: *
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Camper Gender: *
Camper T-Shirt Size: *
Camper Race: *
Camper Physical Disability: *
Your answer
Date of Occurence: *
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Camper Address: *
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Camper City: *
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Camper State: *
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Camper Zip Code: *
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Camper County: *
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Camper Home Telephone: *
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Please list all other family members attending the weekend (Must live within the same home) *
PLEASE INCLUDE: Name, relationship, DOB , t-shirt size and gender
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Name of parent(s) or guardian(s) with whom the child lives: *
Your answer
Relationship to child: *
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Parent/Guardian Day Phone: *
Your answer
Parent/Guardian Street Address: *
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Parent/Guardian City *
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Parent/Guardian State *
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Parent/Guardian Zip Code: *
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Parent/Guardian County: *
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Parent/Guardian Home phone *
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Parent/Guardian Cell Phone *
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Parent/Guardian Work Phone *
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Please describe any special equipment camper is bringing to camp: *
(examples: crutches, wheelchairs, prosthesis)
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Please describe any special needs of camper: *
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Any sight or hearing loss in camper? *
If you answered yes above, please provide any additional information you think will be useful.
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Any behavioral concerns in camper: *
If you answered yes above, please describe.
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List any camper dietary restrictions:
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List any and all camper allergies *
If none, type NONE
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Is there anything else you would like us to know about your camper?
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Are there any special needs or equipment that may apply to other family members? *
Please provide name and concern or need. If none, type NONE.
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Are there any dietary restrictions for any other family member? *
Please provide name and detail. If none, type NONE.
Your answer
Are there any behavioral concerns for any other family member? *
Please provide name and concern.If none, type NONE.
Your answer
Are there any allergies for any other family member? *
Please provide name and concern. If none, type NONE>
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