Clone of Camp Hope CAMPER APPLICATION 2025
  • Camp Purple Pines provides an opportunity to make new friends and develop a sense of accomplishment in a safe & fun environment! 

    For kids with epilepsy ages 10 - 17

    When: July 17-19, 2026

    Where: Hidden Paradise | 470 W 500 N | Fairfield, Idaho | 83327

    This camp is FREE of charge thanks to many generous donors and sponsors!

    Space is limited and registration ends April 3, 2026

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    Please note, Camp Purple Pines is thoughtfully designed as a youth-only experience where campers can build confidence, independence, and meaningful friendships in a safe, supportive environment alongside peers who share similar experiences. To help create this space, parents, guardians, siblings, and family members do not remain on-site during camp hours and do not observe or participate in camp activities.

    Parents/guardians are responsible for drop-off and pick-up at designated times. Our trained staff and volunteers closely supervise all campers, and families will be contacted promptly if any medical, behavioral, or safety concerns arise. An emergency contact number for camp leadership will be provided to all families.

    By submitting this application, families acknowledge and agree to this policy.

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    **To be considered, campers must be able to manage personal care (toileting, dressing and feeding) without assistance.**

  • CAMPER INFORMATION

  • Gender*
  • PARENT/GUARDIAN INFORMATION

  • Format: (000) 000-0000.
  • EMERGENCY INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • CAMPER'S MEDICAL INFORMATION

  • I authorize administration of the following over the counter medications by camp medical staff for my child if necessary:
  • Camper Shirt Size*
  • Informed Consent and Acknowledgement

    I hereby give my approval for my child’s participation in any and all activities prepared by the Epilepsy Foundation of Idaho during Camp Purple Pines. In exchange for the acceptance of child’s candidacy by the Camp Purple Pines, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

    In case of injury to said child, I hereby waive all claims against the Epilepsy Foundation of Idaho, including all camp counselors, volunteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. 

  • Behavior Agreement                                                                                         

    If at any time during the camp my child’s behavior is disruptive and unmanageable to the extent of diminishing another camper’s experience and/or requiring too much one-on-one assistance from staff, I will pick him/her up at the request of EFI. I understand that the definition of behavior as “disruptive or unmanageable” will be determined by the camp staff on an as-needed basis exercising their discretion. I further understand that it will be my responsibility to pick my child up as quickly as possible upon request. I verify that I have discussed this contract with my child, so they are aware of the behavioral expectations and consequences.

  • Consent for Photographs

    I hereby grant the Epilepsy Foundation of Idaho permission to use my child's photograph in any of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Epilepsy Foundation of Idaho. I hereby irrevocably authorize the Epilepsy Foundation of Idaho to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. I hereby hold harmless, release, and forever discharge the Epilepsy Foundation of Idaho from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or mayhave by reason of this authorization.

  • Consent for Transportation
    I do hereby give permission to Camp Purple Pines or any designated staff member of the camps to transport my child in order to seek medical care in case of emergency or to activities on the perimeters of the campgrounds.

  • Consent for Release of Information from Medical Personnel
    I hereby authorize any school or medical personnel having records or confidential information regarding my child to disclose such information to the Epilepsy Foundation of Idaho. I certify that this agreement has been made voluntarily. I understand that I may revoke this authorization at any time in writing to the Epilepsy Foundation of Idaho except to the extent that action has already been taken in reliance on it. Without my express revocation, this consent will expire on the day following the final day of the Camp Purple Pines.

  • Consent for Medical Authorization for Treatment
    I hereby authorize and give my consent to the medical personnel of Camp Purple Pines or any licensed physician, nurse practitioner, physician assistant or nurse to perform upon or administer any medical treatment they may deem appropriate during Camp Purple Pines to my child. I hereby give permission to release the results of any necessary medical treatment to Camp Purple Pines. I agree that I am responsible for all costs related to such treatment. I understand that I will be responsible for any medical or other charges in connection to a medical event or necessary treatment for the above-named camper during Camp Purple Pines that he/she is attending, including transportation costs. 

  • Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

  • Date*
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  • OPTIONAL: Camp Purple Pines is a free program made possible through community support and generous donors. There is no cost to attend.Families who wish to make an optional donation to help sustain Camp Purple Pines for future campers may do so during the application process. Donations are entirely optional and do NOT influence camper selection.

  • Donation Amount

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    USD
    Debit or Credit Card
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