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Positive Attitude Camp Application
This section to be completed by a parent / legal guardian.
Note: Payment options are at the conclusion of the camper questionnaire.
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* Indicates required question
Email
*
Your email
Camper's First Name
*
Your answer
Camper's Last Name
*
Your answer
Campers Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Decline to state
Current School Attending in 2020-2021
*
Your answer
Current Grade in 2020-2021
*
6th
7th
Camper's Cell Phone
*
Your answer
Camper's Email
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Parent / Legal Guardian First Name
*
Your answer
Parent / Legal Guardian Last Name
*
Your answer
Parent / Legal Guardian Cell Phone
*
Your answer
Parent / Legal Guardian Email
*
Your answer
Medical Insurance Company Name
*
Your answer
Medical Insurance Group ID Number
*
Your answer
Medical Insurance Member ID Number
*
Your answer
List all medications that the participant has with him/her (prescription or over-the-counter)
Your answer
Check the medication(s) you give permission for an adult staff member to administer to the camper.
*
Acetaminophen (Tylenol)
Calcium Carbonate (Tums)
Diphenhydramine (Benadryl)
Ibuprofen (Advil, Motrin)
None
Required
Does the camper have any current medical/emotional/behavioral/physical conditions (e.g. ADHD, ODD, ADD, anxiety, seizures, diabetes, autism).
*
Yes
No
If necessary, please share with us anything you think we should know about the previous question so we can provide the best experience for your camper.
Your answer
Please select a camp session
*
Positive Attitude (Entering 7th or 8th) Session #1 (July 18-21, 2021)
Positive Attitude (Entering 7th or 8th) Session #2 (July 23-26, 2021)
If the session selected is full, can the camper attend the other session?
*
Yes
No
T-shirt Size (Adult Sizes)
*
Small
Medium
Large
X-Large
XX-Large
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