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Register a camper for Camp Rise Up
Camp Rise Up 2022 promises to be another year of education, fun, and friendship!
If your child would like to join us, please complete this form.
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* Indicates required question
Parent/guardian name
*
Your answer
Contact phone number
*
Your answer
Email address
*
Your answer
Where do you currently live?
*
Camp Rise Up gives first priority to campers residing in temporary housing. Second priority is given to campers residing in public housing.
Temporary Housing (Shelter, Safehouse, hotel, or doubled up)
Public Housing (NYCHA)
Other:
Are you or your children/child a patient of The Floating Hospital?
*
Priority is given to patients of The Floating Hospital.
Yes
No
Child's legal name
*
Your answer
Child's preferred name (if different than legal name)
Your answer
Age
*
Campers must be aged 12-15 by the start of camp. Exceptions will be made for 16 and 17 year-olds on a case-by-case basis.
Your answer
Child's date of birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other:
Shirt size
*
All sizes are adult unisex. The size chosen will be the size your child will receive at camp.
XS
S
M
L
XL
XXL
Is there any other information we should know about your child?
Your answer
Do you have another child to register? *
Yes
No
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