Helping Kids with Hemiplegia CIMT Camp Application 2019
The Helping Kids with Hemiplegia CIMT Camp dates are June 18 - June 25, 2019. We are accepting applications for children ages 4-10 with a diagnosis of hemiplegic cerebral palsy. For detailed camp information, important dates/deadlines and contact information, go to our camp brochure at https://drive.google.com/file/d/1hPRjZiCQkSWEg7GALP3qAR15P4xpwqdv/view?usp=sharing.

To apply for a spot at camp, please take a moment to complete this online application.

Online applications due by NOON (EST) on March 22, 2019. We encourage families to submit applications as soon as possible to avoid missing the application deadline.

If you have any questions, please email helpingkids.unc@gmail.org.

Email address *
Camper's Name (First, Last) *
Your answer
Name camper goes by. *
Your answer
Camper's date of birth (month/day/year) *
MM
/
DD
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YYYY
Parent/Guardian #1(Primary Contact during Camp) *
Your answer
Cell Phone *
Your answer
Address - Street, City, State, Zip Code *
Your answer
Parent/Guardian #2 *
Your answer
Address - Street, City, State, Zip Code *
Your answer
Cell Phone *
Your answer
Please contact me using (click all that apply) *
Required
How many times have you applied to Helping Kids with Hemiplegia CIMT Camp? *
How many years have you attended Helping Kids with Hemiplegia CIMT Camp? *
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