2026 Camp Application - Camper/Sibling

Pre - Registration

For children with cancer ages 6 - 16.
Welcome to Camp Rising Sun's summer camp application. This form is for an Oncology Summer Camp for children diagnosed with cancer, ages 6 - 16. In certain cases, allowances are made for children ages 5 or 17. Please speak to one of the directors for prior approval before completing the application for any child age 5 or 17. For the purpose of this application, "camper" refers to any child who has been diagnosed with or previously treated for cancer. Siblings are allowed on a space available basis. If the camper is an only child, or chooses to not bring a sibling, a friend may attend. Before submitting applications, if your camper wishes to bring a sibling/friend, you MUST contact one of the camp directors for prior approval. Sibling information is to be provided on this form. However, a separate form will need to be sent to the friend's parents. Please email jason.kirkland@camprisingsunms.com to schedule a time to speak to one of our camp directors.

Camp dates are June 01-06, 2026. Camp will be hosted by Camp Kamassa in Crystal Springs, MS.

Please note: This form is for pre-registration only and does not guarantee camp attendance. An additional Participation and Medical Questionnaire, as well as a Physician Evaluation, will be required before your child is approved to attend this summer's camp session.
I acknowledge that I am registering a child with cancer between the ages of 6-16 for overnight Summer Camp.*

Yes
Please include my child in the "Camp in a Box" program.

YesNo

Camper Information

"Camper" refers to child with cancer.
What is your Camper's name (child with cancer)?*

First NameLast Name
{campersname:first}'s Date of Birth?*

MonthDayYear
Date
{campersname:first} is a:*

MaleFemale
How did you hear about Camp Rising Sun?
Please be as specific as possible.

Cancer Diagnosis Information

This section will gather info regarding your Camper's cancer diagnosis.
We are so excited that {campersname:first} wants to join us at Camp Rising Sun! Please tell us a little more about their cancer diagnosis.
Cancer Diagnosis*
Date of Diagnosis*

MonthDayYear
Date
Is {campersname:first} on active treatment?*

YesNo
Name of {campersname:first}'s oncology treatment center.*
Name of Doctor (Oncologist or Pediatrician). Oncologist should be listed if {campersname:first} has been out of treatment for less than a year.*
Child Life Specialist/Social Worker's Name
Name of Child Life Specialist/Social Worker your child works with, if applicable.
Child Life Specialist/Social Worker's Email
example@example.com

Parent/Guardian Information & Emergency Contact

This is the final step for general camper enrollment. Please add any relevant parent/guardian contact information and include at least one emergency contact.
Parent/Guardian 1 Name*

First NameLast Name
Relationship to Child with Cancer?*
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number (Mobile)*
Please enter a valid phone number.
Parent/Guardian 1 Number (Home)
Please enter a valid phone number.
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a second parent/guardian?
Parent/Guardian 2 Name*

First NameLast Name
Relationship to Child with Cancer?*
Parent/Guardian 2 Email*
example@example.com
Parent/Guardian 2 Phone Number (Mobile)*
Please enter a valid phone number.
Parent/Guardian 2 Number (Home)
Please enter a valid phone number.
Parent/Guardian 2 Address (If different from Primary)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

Please note: Emergency Contact MUST be different from parent/guardian. At least one emergency contact should be provided.
Emergency Contact Name:*

First NameLast Name
Relationship to Camper*
Emergency Contact Phone (Mobile)*
Please enter a valid phone number.
Emergency Contact Phone (Home)
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a second Emergency Contact?

YesNo
Emergency Contact Name:*

First NameLast Name
Relationship to Camper*
Emergency Contact Phone (Mobile)*
Please enter a valid phone number.
Emergency Contact Phone (Home)
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Additional Application Requirements
Please note: This application holds an initial place for your child to attend Camp Rising Sun. Additional forms and documents will need to be submitted. These mandatory forms must be submitted by June 1. Please be advised that registration is not 100% complete until all mandatory paperwork has been uploaded. One of the CRS directors will email or call you with instructions to complete mandatory forms and upload required paperwork.

Any child, including campers/siblings/friends, attending Camp Rising Sun must see their physician for a physical within 6 months of attending camp. If the "camper" (child diagnosed with and treated for cancer) has been out of treatment for 1 year or less, this physician needs to be their oncologist. You will need to contact your physician to obtain a valid email address for their participation to complete the required health forms.

Please add info@camprisingsunms.com to your contacts for Camp Rising Sun. You may also wish to add Jason Kirkland, one of the directors for camper enrollment, to your contact list. His cell number is 818-823-1217.

Additional Paperwork Requirements to Attend
- Participation and Medical Questionnaire to be completed by parents for ALL children attending Camp Rising Sun.
- Insurance Card (Front and Back)
Note: Friends will need to be approved and will need to have a separate application completed by their parents. Please contact the camper coordinator to provide that child's parent's email.
Please verify that you are human*
Should be Empty:

Pre - Registration

Camper Information

Cancer Diagnosis Information

Sibling Registration

Parent/Guardian Information & Emergency Contact

Emergency Contact Information

Additional Application Requirements