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Camp GLOW Summer 2024 Interest Form
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* Indicates required question
First Name of Camper
*
Your answer
Last Name of Camper
*
Your answer
Nickname of Camper
Your answer
First and Last Name of Person filling out this form
*
Your answer
Relationship to Camper
*
Your answer
Email address to send communications
*
Your answer
Phone Number for communications
*
Your answer
Street Address of Camper
*
Your answer
City ST Zip Code of Camper
*
Your answer
Where does Camper live?
*
with relative (parent, sibling, grandparent)
in a group home
on own
other
Name of Organization or Guardian of the Camper
*
Your answer
Name of Camper's Day Program/Workplace
Your answer
Name of Camper's Case Manager
*
Your answer
Phone Number of Camper's Case Manager
*
Your answer
Email of Camper's Case Manager
*
Your answer
Which session of Camp GLOW would you like to attend?
*
1st Choice
2nd Choice
3rd Choice
4th Choice
Cannot attend this session
June 17-21 @ St. Andrew by the Bay, Camp St. Claire
July 15-19 @ TBD
July 29-Aug 2 @ St. Ursula, Parkville
Aug 12-16 Msgr. O'Dwyer Retreat House (overnight)
1st Choice
2nd Choice
3rd Choice
4th Choice
Cannot attend this session
June 17-21 @ St. Andrew by the Bay, Camp St. Claire
July 15-19 @ TBD
July 29-Aug 2 @ St. Ursula, Parkville
Aug 12-16 Msgr. O'Dwyer Retreat House (overnight)
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