Camp Appalachia Summer Resident Camp Application
- Please fill out the following form for each child that will be participating in Resident Camp at Camp Appalachia.
- Resident Camp is open to all students between the ages of 7 and 17.
- Scholarships are available due to grant funding for children in Foster Care, Kinship Care, and kids who have a parent incarcerated.
- Questions? Please contact Camp Director Jared Davis at j.davis@campappalachia.org
What week of Resident Camp are you interested in? *
Camper's Information
Please help us get to know your camper
Camper's Full Name *
Camper's Age & Date of Birth (Open to campers ages 7-17) *
Camper's Phone Number - If Applicable
Camper's County of Residence *
Does your child have any allergies? If yes, please list them below.
Does your child have any medications that will need administered throughout the week? If yes, please list/explain below:
Does your camper have any GOALS for the week?
Parent/Guardian Information
Please provide information for parent/guardian in case of emergency.
Emergency Contact(s) Name & Best Phone Number *
Mailing Address *
Email *
*** SCHOLARSHIPS ARE AVAILABLE***
Scholarships are available for children who are in Foster Care, Kinship Care, and Children who have a parent incarcerated.
Contact Me About a Scholarship
By clicking YES, I agree to pay $300.00 per child per week (If No Scholarship Awarded) ) *
Required
How to Pay:
Please make checks payable to "Camp Appalachia".
In memo line write - "Resident Camp Registration"
Mail or Drop Off Payment to Attn: Brenda Good, Church @ The Depot, 6496 Teays Valley Road, Scott Depot, WV 25560
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