Kamp T1D Kids Registration | August 2021
This registration is for youth of all ages and their families to attend the virtual Kamp T1D Kids programs in August 2021. Program is invitation only to Kaiser patients from the Sacramento Valley/central
Valley areas.

Please complete this form in it's entirety (for each T1D camper) to register for the sessions and watch for email communications from DYF leading up to each session.

Our 2021 virtual sessions include:
*Saturday, August 14 - 1pm to 3pm | Outdoor Extraordinaire (Urban Gardening & Extreme Outdoor Scavenger Hunt)
*Thursday, August 19 - 5:30pm to 7:30pm | Craft & Game Night (Rock Painting, Kamp Dinner & Virtual Games)
*Tuesday, August 24 - 5:30pm to 8pm | KTK Kitchen (Main Dish Challenge, Kamp Dinner & Bake-off)
*Saturday, August 28 - 4pm to 5pm | Kampfire & Talent Show (Camper showcase & guest speaker)

It is highly encouraged for families to participate in the virtual sessions with their campers and adult supervision is required during all sessions.

Campers do not need to attend all 4 sessions to be accepted into the virtual camp program - they can participate in all sessions, or join for any they are interested in and available for.

T1D campers will be sent a camp package with a camp shirt, supplies and instructions they will need for session activities. Early registration is key in making sure the package arrives in time for your camper to have what they need.

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Email *
FAMILY & HOUSEHOLD INFORMATION
Parent/Guardian First & Last Name *
Mailing Address (Street, Apt #) *
City *
State *
Zip *
Email (Required for program communications) *
Phone Number *
CAMPER INFORMATION
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade (2021-2022 School Year) *
Gender Identity *
Ethnicity (Select all that apply.) *
Required
Time Diagnosed with T1D *
Required
What DYF programs has your camper attended previously? (Select all that apply.) *
Required
Which Kaiser Permanente clinic does camper current visit for their diabetes care? *
T-shirt Size
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PROGRAM INFORMATION
All programs will be held virtually over zoom. Sessions links will be sent 1-2 days prior to each session.
Which sessions does your camper plan to attend? *
Attending
Not Attending
Unsure
Sat. Aug 14 | 1-3pm | Outdoor Extraordinaire
Th. Aug 19 | 5:30-7:30pm | Craft & Game Night
Tu. Aug 24 | 5:30-8pm | KTK Kitchen
Sat. Aug 28 | 4-5pm | Kampfire & Talent Show
Comments/Questions about Programs:
Do you give DYF permission to share your camper's name, age & parent email in the post-camp roster that is shared with all registered Kamp T1D Kids families? *
A copy of your responses will be emailed to the address you provided.
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