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  • APPLICATION

  • Does The Child Live At The Same Address
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  • Annual Household Income Range
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  •  If available, please provide for any child attending over the age of 13.

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  • If available, please provide for any child attending over the age of 13.

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  • If available, please provide for any child attending over the age of 13.

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  •    
  • If available, please provide for any child attending over the age of 13.

  • More Details...

  • Race/Ethnicity
  • Which of the following issues are presently affecting you and your family?
  • Rows
  • Transportation Needs

  • In an effort to make transportation arrangements that best meets the needs and budget of the organization, please indicate all methods, which you are able to travel?
  • Rows
  • Please indicate any health concerns that may affect you or your other family members’ (who will attend the week retreat) ability to participate in the activities.
  • RELEASE of INFORMATION

    As part of the long-term evaluation of F.R.E.E. we are interested in assessing our program’s impact beyond the summer experience. We would like to share in your family’s progress for a year after your camp experience. For this reason we are requesting your participation in pre and post surveys, and follow-up interviews. We strive to continuously evaluate our program to make it the best summer experience for all participants. We will request that you and your child/children tell us the parts of the program that worked best, which things we should consider changing and keep us informed of the long-lasting impacts.  We value your advice and future recommendations. 
Portions of our evaluation may be reproduced for the purpose of publications, newsletters, or documentary. You and your child or children responses both written and verbal may be incorporated as part  of the evaluation process. 
Participants may be asked to be video taped in order to develop a documentary of F.R.E.E.  Counseling sessions will NOT be video taped.  The families and the relationship restoration team are the only ones who will attend individual and group sessions. 

  • Reload
  • Should be Empty: