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  • CHAMP CAMP July 27-July 31, 2026: One application must be submitted for each camper. All Campers must be between the ages of 7-11 at the time of camp.

  • The drop-off/pick-up location is New Life Christian Church, 31700 Couchez St. Saint Clair Shores, MI 48082

    This form must be completely filled out. The information is vital to the health and well-being of the child. Your application will be returned to you if it is not completely filled out.

  • Questions?

    If you have questions or concerns about Champ Life Kids Camp please contact our volunteer Child Placement Coordinator, Jeni Cupp, at Jeni@mychamplife.com.

  • Child's Information

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  • Gender*
  • This child will be entering this grade in the fall.
  • Child's T-Shirt Size*
  • Is this child a returning Champ Life Camper?*
  • Relationship To Child*

  • Parent/Guardian Information

  • The child is currently living with:*

  • At time of camp, how long will this child have been living in current home?*

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  • This phone is a:*
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  • This phone is a:

  • Caseworker/Child Placement Agency Information

  • Does the child have a caseworker/child placement agency?*
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  • Supervising Agency

  • Is the child an:*

  • Siblings of Child Applying to Champ Life Kids Camp This Summer

    If siblings of this child will ALSO be applying for camp, please provide their information so we can try to get all siblings to camp this summer. A separate registration will need to be completed for each child.

  • Background/Behavior Information

    Please fill this out to the best of your ability. All information shared is confidential. We as Champ Life staff want to make sure this child as well as other campers have a safe, healthy, fun time at camp. This information is extremely helpful and is only shared with camp staff on a "need to know" basis.
  • How often does this child wet the bed at night?*
  • Does this child display aggressive behavior?*
  • Does the child deal with any of the following eating disorders or issues around food?*

  • How would you describe this child's demeanor?*
  • Please let us know if any of the following learning difficulties/disabilities exist for this child.*

  • Has the child been diagnosed with Autism Spectrum Disorder?*
  • How does the child typically handle changes in activities or locations?*
  • How does the child respond to loud or unexpected noises?*
  • When overwhelmed, the child may (check all that apply):*
  • How often does the child interrupt adults while they are speaking*
  • How often does the child act impulsively or distract peers?*
  • Which best describes the child's comfort with group activities?*
  • Which best describes the child's interest in social interaction?*
  • When interacting with others, the child typically:*
  • Which best describes the child's independence with bathroom and hygiene needs?*
  • What helps the child succeed at Camp (check all that apply):*
  • Please let us know how often this child has night terrors.*
  • Please let us know how often this child runs away from a situation or from home.*
  • How often does this child withdraw?*
  • Please let us know if - or how - this child may act out sexually.*

  • HISTORY/STORY: Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!

  • Medical History + Prescription Medication Information

  • Prescription & Over-the-Counter Medications

    ALL MEDICATIONS MUST BE IN ORIGINAL CONTAINER WITH PHARMACY LABEL. If your child is NOT taking any prescription or over-the-counter medications, vitamins, or inhalers to camp, please type "NONE" in each of the boxes.
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  • Permission

    This health history is correct so far as I know, and the above named minor has permission to engage in all prescribed program activities, except as noted. The undersigned do hereby authorize the directors of Champ Life Kids Camp, or such substitute as they may designate, as agent for the undersigned to consent to: X-Ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above minor, which deemed advisable by, and to be rendered under the general or special supervision of any physician and surgeon, licensed under the provision of the Medicine Practice Act or any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, camp or elsewhere. This authorization will remain effective while the above minor is en-route to and from camp, involved or participating in any camp program, unless revoked in writing by the undersigned and delivered to the Director of Champ Life as legal guardian/social worker/other. My permission is given for the minor named in this application to attend Champ Life Kids Camp in the summer of 2026. I agree to hold CHAMP LIFE & their volunteers harmless for any & all damages sustained & suffered in connection with participation in all Champ Life Kids Camp activities.
  • Date*
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