Camp NAWIC Summer 2018
Email Address
Camper's first & last name *
Camper's date of birth (Month/Year) *
Camper's age at time of camp
Camper's school grade (fall 2018) *
Camper's preferred gender pronouns that an individual would like other to use when talking to, or about, that individual (check all that apply)
Name of the camper's school (fall 2018)
Camper's school is
Camper's primary address (include city, state and zip code) *
Camper's mailing address (if different than above)
Caregiver (main) contact first & last name *
Caregiver's phone number *
Caregiver address (if different than camper's)
Caregiver email address
Caregiver relationship to camper *
Does the camper live with the caregiver?
Camper secondary contact person ( if applicable) first & last name
Camper secondary contact person ( if applicable) phone number
Name of person completing application (if not a parent of guardian)
Has the prospective camper attended Camp NAWIC before? *
If yes, which year(s)
How did you hear about Camp NAWIC? Be specific. (Name of online source, school, cafe, previous camper, etc.) *
Camp NAWIC t-shirt size
RACIAL/ETHNIC IDENTITY (OPTIONAL) Creating a multiracial group of campers that reflects Maryland communities is a camp priority. In addition, some of our funders require that the racial/ethnic and economic composition of our camp population be documented. Providing the following information will help us meet our goal of being a multiracial camp and help us continue to receive funding for future camp sessions.
Please check ANY AND ALL that apply, or write in your preferred identity.
Does the camper have any medical needs that camp staff should know about?
Does the camper have any allergy or dietary restrictions?
EXPRESS YOURSELF (REQUIRED) - We ask that you take some time and communicate why you wish to be a part of Camp NAWIC. You may choose how to express yourself. Some ideas: write a letter, draw a picture, make a collage, record or write a song or poem, etc. This is simply a way to focus your attention on why you want to participate. Please do not think of this like an essay for school—have fun with it! We also need to get to know you; your instructors and counselors will be able to see your “Express Yourself” piece and get to know a bit about you before camp starts. Please make sure your piece has your first and last name on it! You can upload a file using google or send an email to info@jacksonmgmtgrp.com. If you are sending a picture, video or other format of expression. In the subject line [YOUR FIRST & LAST NAME] EXPRESS YOURSELF PIECE - CAMP NAWIC 2018
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