Special Days Camps 2023 Summer Camp Camper Application

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Please use this form to register up to five campers for our 2023 summer programs. Once we have received the application form we will be in touch with additional details.

2023 Summer Program Dates:
Partners (siblings) Program: Sunday, July 30 - Sunday, Aug. 6th
Special Days (children who have been diagnosed with cancer) Program: Sunday, Aug. 6th - Saturday, Aug.12th

Parent / Guardian Name *

(first and last)

Street Address *

City *

State *

Zip Code *

Parent / Guardian Email Address *

Parent / Guardian Phone Number *

(please provide a number including area code where you can be reached while your child is at camp)

Secondary Contact *

(include name, relationship and phone number including area code)

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