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Guardian Interest Form
Youth Information
First Name
Last Name
Preferred Pronouns
Birthdate
Gender
Current Grade and School
Expected Grade and School Next Year
Guardian Information
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
example@example.com
Preferred Language
General History and Goals
How did you hear about this program?
Is this youth currently receiving services? (Counseling, etc.)
Has this youth processed their trauma with a mental health professional? If yes, where, with whom, and for how long?
Is there anything about this youth that would be helpful for us to know in advance?
What do you believe this youth will gain from involvement with Camp Hope America?
Has this youth attended an overnight camp in the past? If yes, when? How was the experience for them?
Safety
Has this youth been exposed to domestic violence or other form of child abuse? When?
Has this youth been in a safe place and out of harm for a minimum of three months?
For safety reasons, is there any person your child should not be in contact with? If yes, please share their name, birthdate, and their relationship to them.
Submit
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