Camp Del-Haven Application 2022

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Camp Del-Haven 887 NW 1901 Rd, Lone Jack, MO 64070 (816) 425-0460.

This application must be filled out by a parent or legal guardian. A new application will have to be submitted for each new child.

You will receive an email confirmation once your application has been reviewed. A follow-up email and letter will be sent at a later time to confirm your child's admittance for our summer camp program and give you more specific details.

Email *

First Name of Camper *

Last Name of Camper *

Gender *

Male

Female

Name of Parent/Guardian (First and Last Name) *

Parent Phone Number *

Mailing Address (Include Apt. #) *

City, State Zip Code *

Birthday (month, day, birth year) *

YYYY

Age camper will be during camp session (see next question for dates) *

Select a camp date for your child - Check all dates that your child will be available to attend. (Only 9 year old campers are permitted to attend either age group session). *

6 to 9 Boys and Girls: June 13-16 (Session 1)

9 to 12 Girls Only: June 20-23 (Session 2)

9 to 12 Boys Only: June 27-30 (Session 3)

9 to 12 Girls Only: July 11-14 (Session 4)

6 to 9 Boys and Girls: July 18-21 (Session 5)

9 to 12 Boys Only: August 1-4 (Session 6)

Required

How will your child get to camp? *

Would you prefer a day camp option for your child? (This is only available if you will be providing your own transportation to/from camp each day. *

Describe any physical handicaps or allergies that we should know about. *

List any medication your child regularly takes. *

Who is your child's physician? *

When was your child last examined? *

Do we have permission to distribute Children's Tylenol to your child for minor headaches or other minor aches and pains? *

In case of accident or illness the primary caregiver will be notified first. Please list names and phone numbers for two other people who can be contacted if the primary caregiver can't be reached. *

Please list any persons other than yourself who are allowed to pick up your child. Children will not be released to unauthorized persons. *

Waivers and Conditions: Pictures (no names) taken at camp may be used for advertisement purposes. (Examples: brochures, support newsletters, web pages, etc.) Camp Del-Haven is released from any liability in the event of an illness or accident that may occur to any camper. Each camper must be insured by their own provider. By agreeing below you give Camp Del-Haven the right to arrange for any special services or medical attention necessary for the camper’s welfare and good health. In such situations the camp will attempt to notify the parents/guardians as soon as possible. The parents/guardians are responsible for any expenses that may result from such services. I affirm that the information given is correct and accurate. I have carefully read the waivers and conditions of enrollment and agree to abide by them. *

Agree

Disagree

Name of Parent / Legal Guardian who is filling out the application. *

How did you hear about Camp Del-Haven? *

A copy of your responses will be emailed to the address you provided.

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