Summer Camp Application Form for Foster Children (Ages 10-14)
*Note: This is the first portion to an approval process. Not all applicants will be a fit for our program as there are specific requirements that need to be met. A decision will be made after our applications are reviewed.
Participant's Full Name
First Name
Last Name
Participant's Date of Birth
-
Month
-
Day
Year
Date
Participant's Age
Gender
Male
Female
Did the participant's foster case originate in Yavapai County OR does the participant currently reside in Yavapai County?
Yes
No
If No, what county does this participant reside in?
Parent/Guardian Full Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Emergency Contact Name
First Name
Last Name
DCS Case Worker
First Name
Last Name
DCS Case Worker Email Address
example@example.com
DCS Case Worker Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Any allergies or medical conditions we should be aware of?
Where did you hear about us?
**transportation to the camp is not provided
Submit
Should be Empty: