EmailMe Form - Camp Conquer Application 2024

Which week will your child attend?
(Please Note: Your child will only be allowed to attend one camp.) *

Child's Name: *

First Last

Child's Date of Birth: *

Child's Age (at the time of Camp): *

Please Select Your Child's Gender: *

Male

Female

What grade will your child be completing in May 2024? *

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent/Legal Guardian: *

First Last

Parent/Legal Guardian's Phone Number: *

### - ### - ####

Parent/Legal Guardian's Email: *

Second Emergency Contact: *

First Last

Second Emergency Contact's Phone Number: *

### - ### - ####

Has your Child attended Camp Conquer before? *

Yes

No

Child's T-Shirt Size: *

Please list any medical conditions including allergies, medications, special needs, etc. If this does not apply to your child, please list n/a. *

Has your child ever been diagnosed with a disability? (This will NOT determine your child's eligibilty to attend Camp.) *

Yes

No

If you answered yes above, please explain below. If this does not apply to your child, please list n/a. *

List any behavioral disorders and/or mental health diagnosis below. Please include any other information you would like us to know for the week of Camp. *

How did you hear about Camp Conquer? *

AUTHORIZED PICK UP:

Please list the persons authorized to pick up your child, including yourself. Each authorized person must be at least 16 years old. The child will not be allowed to leave Camp with anyone not listed below. Authorized persons may be required to show identification to Camp Staff. *

First Last

Additional Authorized Person

First Last

Additional Authorized Person

First Last

Additional Authorized Person

First Last

Please share with us the reason your child is attending Camp Conquer! Please be thorough as this helps us to be more prepared for camp activities. *

Please upload a photo of the child who will be attending camp. *

Please upload a photo of the loved one who died.

Please click on the "Camp Conquer Consent Forms" button below to COMPLETE your child's registration.

1 / 2