Youth Health & Registration Form - HEARTS
HEALTH EDUCATION AND RELATIONSHIP TRAINING SERVICES (HEARTS) CAMP
This form should be completed for each young person participating in HEARTS Camp. The gathered information is confidential and will be treated accordingly. It is requested in order to assist facilitators in providing the best possible experience for youth attending the camp. Please fill out details of medication fully (names of medication, dosages, inhalers etc.)
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This is the HEARTS Camp for HIGH SCHOOL students, if you are looking for the FRIENDS Camp for MIDDLE SCHOOL students, please use the link below.
REFERRED BY: (NAME OF CHURCH OR AGENCY)
PREFERRED Camp Date:
9/18/2021 & 9/25/2021 (in-person) The Next Stepp Center: 1221 22nd Street South, St. Petersburg, FL 33712
10/2/2021 & 10/9/2021 Virtual Camp
10/23/2021 & 10/30/2021 (in-person) The Next Stepp Center: 1221 22nd Street South, St. Petersburg, FL 33712
PREFERRED Camp Location
SECTIONS A, B, and C are about the young person. SECTION D is about the parent/guardian.
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