Camper Interest and Referral

About Camp Mariposa: Youth ages 9-12 attend weekend camps up to six times a year. Weekend camps offer fun, traditional camp activities combined with education and support sessions led by mental health professionals and trained adult mentors. Additional social activities are offered for youth and their families throughout the year. Camp Mariposa South Bend also offers programs for teens ages 13-17. All program activities are free to families. Camp Mariposa South Bend is part of Eluna’s national Camp Mariposa program.

Camp Mariposa:

Reduces feelings of isolation and guilt
Provides a safe place for youth
Fosters peer bonding
Educates campers about the disease of addiction
Teaches positive life skills

Interested Youth's Name

First NameLast Name

Name of the Person Completing this Form

First NameLast Name

Your Relationship to Interested Youth

IE: Parent, Case Manager, etc.

Camp Type

Interested Youth's Gender:

Date of Birth

Parent/Guardian

First NameLast Name

Interested Youth's City or County:

City or County

Cell Phone of Parent/Guardian

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email

example@example.com

Whose addiction impacts the interested youth?

If you have questions, email the Camp Mariposa Coordinator. For more information about the national Camp Mariposa program, visit Eluna Network.

You'll be contacted to discuss whether your intersted youth is a good fit for Camp Mariposa, and if yes, directed to the full application.