Camp Bluebird

Camp Bluebird Application

Camp Bluebird is an overnight camp for cancer patients and survivors ages 18 and older, sponsored by St. Dominic Comprehensive Cancer Program. The camp is for anyone who has ever been diagnosed with cancer whether under treatment, just finished treatment or cancer free for years.

Please complete the form below to apply.

If you have questions or prefer a paper application, please contact Peggy Stansell, Camp Bluebird coordinator, at Peggy.Stansell@fmolhs.org.

Your Information:
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Sex*

MaleFemale
Race*
Occupation*
Phone*
Please enter a valid phone number.
Religious Preference*
Hobbies, Interests, Clubs*

Emergency Contact 1
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.
Relationship*

Emergency Contact 2 (optional)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Please enter a valid phone number.
Relationship