Recreational Programs for Children and Young Adults with Multiple Disabilities

Camp Eligibility Application

The form below is to apply for an interview with the camp director. The purpose of that interview is to meet your child and determine eligibility for attendance at the requested camp.

Please complete the form, making sure to provide all information marked "required". If all required information has been provided, you will be be contacted by the director to set up the eligibilty interview.

Parent/Guardian Information
First Name (required)
Last Name (required)
Street Address (required)
City (required)
State (required)
Zip (required)
Work Phone (e.g., 123-456-7890) (required)
Home Phone (e.g., 123-456-7890) (required)
Fax (e.g., 123-456-7890)
Email (required)
What is the best way for us to contact you?  Work phone
 Home phone
How did you hear about our program?  Word of mouth
 Camp Fundraiser
 Newspaper Advertisement
Camper Information
First Name (required)
Age (required)
Sex  Male
What school or program does he/she attend?
To which camp are you applying?  (required)  Camp Sunshine
 Camp Snowflake