Camper Information Form
Email *
1. Which Camp Summit are you registering for? *
Required
2. Camper Information (Please enter your child's name and information)
First Name
Last Name
Age at the beginning of Camp.
Grade child will enter in September
Prefers to be addressed as:
Gender Identification
Clear selection
T-shirt size:
Clear selection
3. Have you attended the camp you are applying for before?
Clear selection
Comment:
Family Information
4. Name of Parent or Guardian (Primary Contact)
First Name
Last Name
5. Mailing Address:
Street Address
City
State
Zip
6. Cell Phone
7. Email Address
8. Occupation
9. Work/Day Phone
10. Name of Parent or Guardian (Secondary Contact)
First Name (Secondary Contact)
Last Name (Secondary Contact)
11. Mailing Address (Secondary Contact):
Street Address (Secondary Contact)
City (Secondary Contact)
State (Secondary Contact)
Zip (Secondary Contact)
12. Cell Phone
13. Email Address
14. Occupation
15. Work/Day Phone
To Be Completed by the Parent or Guardian
16. Has your child been formally identified as gifted; or is your child in a gifted program at school; or is your child home schooled primarily due to special needs related to advanced abilities? Please describe assessments given or abilities demonstrated.
17. What talent(s) does your child possess? What is/are your child's particular strength(s) and interest areas?
18. What are challenge areas for your child or less developed abilities that would benefit from extra support?
19. Why do you want your child to attend this camp?
20. Has your child attended overnight camp before?
Clear selection
21. If yes, what camp(s) did he/she attend? Did your child enjoy this/these camps? what did he/she enjoy the most? What did he/she enjoy the least?
22. Are any friends of your child planning on attending camp with your child? If so, please list names:
23. Name(s) and age(s) of sibling(s):
24. Are any siblings planning to attend Camp Summit? If yes, which camp (West, East, Both)?
25. Does your child have any allergies? If so, what medications does he or she take? Does he/she us an EpiPen? Are any allergies (e.g., peanuts) life-threatening?
26. Does your child take any other medication? If so, please indicate medication and condition. Please also list any other medical conditions that do not require any medication.
27. Does your child have any special dietary needs other than food allergies mentioned above? Any food restrictions needs to be communicated to us 3 weeks prior to camp for us to be able to accommodate.
28. Has your child been diagnosed with any emotional conditions (e.g. depression, anxiety)?
29. Has your child been diagnosed with any learning or developmental disorders (e.g., ADD/ADHD Asperger's Disorder, dyslexia)?
30. Does your child have any special needs?
31. Does your child swim? If so, how well?
32. Is there anything else you would like to share with us about your child?
To Be Completed by the Camper
33. Do you wish to attend camp?
Clear selection
34. What do you think you will like most about camp?
35. What do you want to get out of your camping experience?
36. What activities do you want to participate in the most?
37. When are you the happiest?
38. When do you usually like to get up in the morning?
39. When do you like to go to bed at night?
40. Is there anything else you would like to tell us about yourself?
Thank you for completing the Camper Information form.
A copy of your responses will be emailed to the address you provided.
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