2018 Camp AmeriKids Camper Application

camp dates: Sunday, August 5th - Saturday, August 11th

This form must be filled out by a parent or legal guardian.

You can fill out the application online or download a PDF of the form:


Today's date *
Today's date
Camper's name *
Camper's name
Date of birth *
Date of birth
Address *
Address
Which categorie(s) best describe(s) the camper? *
Please select all that apply.
Camper's Social Worker/Case Manager's Information OR Guardian's Social Worker/Case Manager
If Applicable.
Name
Name
Phone
Phone
Pager
Pager
Guardian's Information
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Other Phone
Other Phone
Please Fill in the Following About Applicant's SIBLINGS
SIBLING #1
Name
Name
SIBLING #2
Name
Name
SIBLING #3
Name
Name
SIBLING #4
Name
Name
ANY ADDITIONAL SIBLINGS
INCOME
To be kept confidential.
For example: food stamps, TANIF, etc.
CAMPER MEDICAL HISTORY
To be kept confidential.
Please select YES or NO for any known medical or sychological concerns, giving explanations if applicable.
Asthma