Camp Cadet of Somerset County Candidate Short Application

Important Notice:

This form is not fully HIPAA compliant. Submit only the health related information you are comfortable sharing. Any specific Medical Information should be conveyed in person, over the phone as arranged with Camp Cadet Board President, Mark Kasterko at mkasterko@somersetcampcadet.org
Candidate Information
Candidate Name*

First NameMiddle NameLast NameSuffix
Gender*
Date of Birth*

MonthDayYear
**Applicant must be at least 13 yrs of age at the start of camp but may not have reached 16 yrs of age during or prior to completing camp.**
Address*

Street Address

CityState

Zip Code
Current Grade Level*
School District that candidate currently attends*
Parent 1 / Guardian 1 Information
Name of Parent 1*

First NameLast Name
Relationship to candidate*
Primary Phone for Parent 1*
Please enter a valid phone number
Secondary Phone for Parent 1
Please enter a valid phone number.
Email for Parent 1*

Confirmation Emailexample@example.com
Parent 2 / Guardian 2 Information
Name of Parent 2

First NameLast Name
Relationship to candidate
Primary Phone for Parent 2
Please enter a valid phone number.
Secondary Phone for Parent 2
Please enter a valid phone number.
Email for Parent 2

Confirmation Emailexample@example.com
Is the Candidate covered by Medical Insurance?*

YesNo
Has the Candidate previously applied to this Camp Cadet Program? If so, when?*

YesNo
Year Candidate previously applied to Camp Cadet
Photo Submission

Please upload a current photo of candidate. A photo is required if you are chosen to attend camp and will be expected to be supplied at the interview.
Photo Upload

Cancelof
OPTIONAL: Use the space below to provide additional notes that may relate to the candidates's application to Camp Cadet.

0/500
Please verify that you are human*
Should be Empty:

Candidate Information

Parent 1 / Guardian 1 Information

Parent 2 / Guardian 2 Information

Photo Submission