Holiday Party Wait List

SIGN UP FOR THE HOLIDAY PARTY WAIT LIST

This event is currently at capacity. Please sign up for the wait list below. It is not uncommon to move off the wait list; we will let you know right away if spaces become available. All fields marked with * are required and must be filled.
Your Name*

First NameLast Name
Email address:*
example@example.com
Has anyone in your family participated in a Camp Casco program before?*

YesNo
Welcome back!
We're happy you're here!
Eligibility
How did you hear about this event?*
Please share a little bit about your family's experience with childhood cancer.*
Please provide the name and contact information of a medical professional familiar with your family's childhood cancer experience to help us confirm your eligibility for our programs. By providing this information, you give Camp Casco permission to contact this individual to confirm your family's eligibility for this free program.
Name of Medical Professional*
Name of Hospital / Clinic*
Hospital / Clinic Phone Number*
Name of child who was diagnosed with cancer in your family*
Date of birth for child who was diagnosed with cancer in your family*

MonthDayYear
Cancer diagnosis*
Phase of Treatment*
Participant Information
How many adults from your family would like to attend?*
At least 1 parent or guardian must stay on the premises at all times
Name of Adult 1*
Name of Adult 2
How many children between the ages of 3-17 would like to participate in the Secret Santa gift exchange?*
Kids ages 3-17 are eligible to participate in the Secret Santa gift exchange. Kids under the age of 3 are able to attend, but will not participate in the gift exchange.
Name & age of Child 1*
Child 1's favorite movies, TV shows, books, or characters:*
Child 1's T-shirt size (include adult or child size):*
Any specific items on Child 1's wish list? Any other interests or additional information that will help our secret shoppers? *
Name & age of Child 2*
Child 2's favorite movies, TV shows, books, or characters:*
Child 2's T-shirt size (include adult or child size):*
Any specific items on Child 2's wish list? Any other interests or additional information that will help our secret shoppers? *
Name & age of Child 3*
Child 3's favorite movies, TV shows, books, or characters:*
Child 3's T-shirt size (include adult or child size):*
Any specific items on Child 3's wish list? Any other interests or additional information that will help our secret shoppers? *
Name & age of Child 4*
Child 4's favorite movies, TV shows, books, or characters:*
Child 4's T-shirt size (include adult or child size):*
Any specific items on Child 4's wish list? Any other interests or additional information that will help our secret shoppers? *
Name & age of Child 5*
Child 5's favorite movies, TV shows, books, or characters:*
Child 5's T-shirt size (include adult or child size):*
Any specific items on Child 5's wish list? Any other interests or additional information that will help our secret shoppers? *
Name & age of Child 6*
Child 6's favorite movies, TV shows, books, or characters:*
Child 6's T-shirt size (include adult or child size):*
Any specific items on Child 6's wish list? Any other interests or additional information that will help our secret shoppers? *
Will any children from your family be attending, but not participating in the shopping activity (ex: kids under age 3; kids who are unable to shop for any reason)? If yes, please share their names and ages.*
Health & Safety
Does any family member have allergies we should be aware of?*
Does any family member carry an EpiPen or an inhaler for any reason?*
If yes, please describe.*
Does any family member have dietary restrictions we should be aware of?*
If yes, please describe.*
Does any family member have other health issues or concerns we should be aware of?*
If yes, please describe.*
If space becomes available, would you like to receive text message reminders about this event?*

YesNo
Phone number*
Please enter the phone number where you would like to receive text notifications. Standard messaging rates apply.
Participation Authorization (scroll to read)
Should be Empty:

SIGN UP FOR THE HOLIDAY PARTY WAIT LIST

Welcome back!

We're happy you're here!

Eligibility

Participant Information

Health & Safety