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Camper Information Form
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Email
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1. Which Camp Summit are you registering for?
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West - Marin Headlands, California
East - North Bay Adventure, Maryland
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2. Camper Information (Please enter your child's name and information)
First Name
Your answer
Last Name
Your answer
Age at the beginning of Camp.
Your answer
Grade child will enter in September
Your answer
Prefers to be addressed as:
Your answer
Gender Identification
Female
Male
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T-shirt size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Xtra Large
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3. Have you attended the camp you are applying for before?
Yes.Use comment box to indicate which year(s) and location(s) you attended.
No
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Comment:
Your answer
Family Information
4. Name of Parent or Guardian (Primary Contact)
First Name
Your answer
Last Name
Your answer
5. Mailing Address:
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
6. Cell Phone
Your answer
7. Email Address
Your answer
8. Occupation
Your answer
9. Work/Day Phone
Your answer
10. Name of Parent or Guardian (Secondary Contact)
First Name (Secondary Contact)
Your answer
Last Name (Secondary Contact)
Your answer
11. Mailing Address (Secondary Contact):
Street Address (Secondary Contact)
Your answer
City (Secondary Contact)
Your answer
State (Secondary Contact)
Your answer
Zip (Secondary Contact)
Your answer
12. Cell Phone
Your answer
13. Email Address
Your answer
14. Occupation
Your answer
15. Work/Day Phone
Your answer
To Be Completed by the Parent or Guardian
16. Has your child been formally identified as gifted; or is your child in a gifted program at school; or is your child home schooled primarily due to special needs related to advanced abilities? Please describe assessments given or abilities demonstrated.
Your answer
17. What talent(s) does your child possess? What is/are your child's particular strength(s) and interest areas?
Your answer
18. What are challenge areas for your child or less developed abilities that would benefit from extra support?
Your answer
19. Why do you want your child to attend this camp?
Your answer
20. Has your child attended overnight camp before?
Yes
No
Clear selection
21. If yes, what camp(s) did he/she attend? Did your child enjoy this/these camps? what did he/she enjoy the most? What did he/she enjoy the least?
Your answer
22. Are any friends of your child planning on attending camp with your child? If so, please list names:
Your answer
23. Name(s) and age(s) of sibling(s):
Your answer
24. Are any siblings planning to attend Camp Summit? If yes, which camp (West, East, Both)?
Your answer
25. Does your child have any allergies? If so, what medications does he or she take? Does he/she us an EpiPen? Are any allergies (e.g., peanuts) life-threatening?
Your answer
26. Does your child take any other medication? If so, please indicate medication and condition. Please also list any other medical conditions that do not require any medication.
Your answer
27. Does your child have any special dietary needs other than food allergies mentioned above? Any food restrictions needs to be communicated to us 3 weeks prior to camp for us to be able to accommodate.
Your answer
28. Has your child been diagnosed with any emotional conditions (e.g. depression, anxiety)?
Your answer
29. Has your child been diagnosed with any learning or developmental disorders (e.g., ADD/ADHD Asperger's Disorder, dyslexia)?
Your answer
30. Does your child have any special needs?
Your answer
31. Does your child swim? If so, how well?
Your answer
32. Is there anything else you would like to share with us about your child?
Your answer
To Be Completed by the Camper
33. Do you wish to attend camp?
Yes
No
Clear selection
34. What do you think you will like most about camp?
Your answer
35. What do you want to get out of your camping experience?
Your answer
36. What activities do you want to participate in the most?
Your answer
37. When are you the happiest?
Your answer
38. When do you usually like to get up in the morning?
Your answer
39. When do you like to go to bed at night?
Your answer
40. Is there anything else you would like to tell us about yourself?
Your answer
Thank you for completing the Camper Information form.
A copy of your responses will be emailed to the address you provided.
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