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Camp CARE Registration Form

Camp CARE Registration Form

  • Family Stresses

  • Alcohol & Other Drug Concerns

    Family member(s) who has/have an alcohol or other drug use concern. If none, please put N/A.
  • Please list participants who will be attending the parent/caregiver educational support component.

    Children ages 3 to 5 must have a parent/caregiver stay and attend the parent group.
  • Child One Information

  • Child Two Information

    If you do not have a second or third child to register, please skip the group of questions and continue registration form with Emergency Contact Information.
  • Child Three Information

    If you do not have a third child to register, please skip the group of questions and continue registration form with Emergency Contact Information.
  • Emergency Contacts

    Please list 2 different people that could be contacted in case of an emergency.
  • List anyone who may be picking up your child/children other than yourself:

  • Consent

    Parent Guardian by typing your name below you give permission for my child/children to participate in the CARE Youth Support Camp Program. I understand the significance and importance of this program and I will take an active role in this experience and will support my child’s understanding of the concepts and ideas it presents. I also understand that if the site director suspects that the person designated to pick up my child is under the influence or intoxicated, that an alternative ride home will be identified.
  • Permission for Photography

  • This field is for validation purposes and should be left unchanged.