Summer Day Camp 2021 Eligibility Form

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Please fill out this brief eligibility form. Our office will contact you with next steps for completing registration.

Child's Full Name *

Child's Gender *

Child's Date of Birth *

YYYY

Caregiver's Full Name *

Caregiver Phone Number *

Which week of camp are you registering your child for? *

Week One (Boys and girls, Ages 10-12)

Week Two (Girls, Ages 13-14)

Please add me to a waitlist for future camp opportunities.

My child... *

Is currently in foster care.

Is adopted.

Has previously been in foster care.

Is my biological child.

Are you currently in, or have you received in the past, services from Spirit Reins? *

Yes

Would you like to be added to the Spirit Reins newsletter to stay up to date on programming?

Yes, please.

No, thank you.

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