Camp Steele Application

Camp Steele Registration Form

If you are a current High Rocks participant and are committed to attending Camp Steele, please fill out this form, and we will send camp paperwork when it becomes available.
First Name:*
Last Name:*
Preferred Email Address*

PersonalAlternate
Personal Email:
Alternate Email (for example, your parent's email):
Street Address:*
City:*
State:*
Zip Code:*
County:*
Preferred Phone Number Type*

HomeCellI don't have a phone
Home Phone Number:
Cell Phone Number:
Date of Birth:*
High School Graduation Year:*
GPA:*
I am in:*

7th grade8th grade9th grade10th grade11th grade12th grade
What is your t-shirt size?

SMLXLXXLXXXLOther
Who do you currently live with?*
Tell us about your living situation

I live with one or both parentsI live with someone other than my parentsI am living on my own/support myself independentlyI am part of the foster care program or otherwise in the custody of the stateI am homeless (see definition below)Other
Homelessness Definition
High Rocks follows the McKinney-Vento Act's Definition of "Homeless" for Children and Youth.

The definition specifically includes youth living in emergency shelters, motels, hotels, trailer parks, cars, parks, public spaces, or abandoned buildings, and those sharing the housing of other persons due to loss of housing, economic hardship, abuse, trafficking, or a similar reason including doubling-up or couch surfing.
It is important to us that low income families are part of our programs. Does your family receive public assistance? For example: public assistance to help with rent, food, or heat.

YesNoOther
Parent/Guardian Full Name:*
Parent/Guardian Email:*
Parent/Guardian Occupation:*
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Parent/Guardian Highest Education Level:

Pre-High SchoolSome High SchoolHigh School Diploma/GED Certificate/Associate's Degree Bachelor's DegreeAdvanced DegreeUnknown
2nd Parent/Guardian Full Name:
2nd Parent/Guardian Email:
2nd Parent/Guardian Occupation:
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Will you be a first generation college student?

Yes, neither of my custodial guardians graduated with a 4-year degreeNo, one or both of my custodial guardians graduated with a 4-year degreeMaybeIt's complicated, or I'm not sureOther
Citizen Status

I am a US CitizenI am a US permanent residentI am an international studentOther
Gender

FemaleMaleTrans and/or non-binaryI prefer not to sayOther
Are you a member of a military family?

YesNoI don't knowOther
Are you a member of a verteran family?

YesNoI don't knowOther

Identity

	Me
Differently-abled, Learning Disorder, or other
LGBTQIA+
Hispanic or Latino/a
White
Black or African
American Indian or Alaskan Native
Middle Eastern or North African
Hawaiian
Asian
Non-native English Speaker

What other aspects of your identity would you like to share?
Should be Empty:

Camp Steele Registration Form