VIRTUAL Camp Genesis 2020 Application
Camp Genesis is a VIRTUAL camp experience for children & teens entering grades 4-9 affected by cancer in their family. Camp Genesis is a collaborative camp partnership with Gilda’s Club Quad Cities, Camp Shalom and Genesis Cancer Care Institute.

Camp Genesis will run from June 22, 2020 to June 26, 2020.

Please note, this is an application form for your child/children to be considered to attend Camp Genesis 2020. Application deadline is set for April 23, 2020. Priority will be given to first-time campers, those with a loved one in active treatment and allotted cabin availability. A selection committee will determine camper eligibility and families will be notified by the week of April 27, 2020. Once selected, a registration packet will be sent along with the link to complete the required forms.

For more information please visit http://www.gildasclubqc.org/camp.

For additional questions, please contact Kelly Craft, Program Manager, at Gilda’s Club Quad Cities at (563) 326-7504 or email kcraft@gildasclubqc.org.
FAMILY INFORMATION
Parent/Guardian Name: *
Home Mailing Address: *
City, State, Zip Code: *
Email Address: *
Home Phone: *
Cell Phone:
Please note which immediate household member has been directly affected by cancer: *
Please indicate how long it has been since the family member's last treatment for cancer: *
CAMPER 1 INFORMATION
CAMPER 1: First and Last Name *
CAMPER 1: Sex *
CAMPER 1: Grade Entering in Fall 2019 *
CAMPER 1: T-Shirt Size. Please include if youth or adult size. *
CAMPER 1: Is this your camper's first time for camp with Gilda's Club? *
CAMPER 2 INFORMATION
CAMPER 2: First and Last Name
CAMPER 2: Sex
Clear selection
CAMPER 2: Grade Entering in Fall 2019
Clear selection
CAMPER 2: T-Shirt Size. Please include if youth or adult size.
CAMPER 2: Is this your camper's first time for camp with Gilda's Club?
Clear selection
CAMPER 3 INFORMATION
CAMPER 3: First and Last Name
CAMPER 3: Sex
Clear selection
CAMPER 3: Grade Entering in Fall 2019
Clear selection
CAMPER 3: T-Shirt Size. Please include if youth or adult size.
CAMPER 3: Is this your camper's first time for camp with Gilda's Club?
Clear selection
Do you have any other children in your household who would like to attend camp? If so, Gilda's Club Quad City staff will reach out to you to get their information. You can also contact Kelly Craft at kcraft@gildasclubqc.org or by calling 563.326.7504.
Clear selection
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