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Camp Waves of Hope
Camper Application Form 2024
Please Indicate Which Program You Are Applying For:
Ages 5-7 Day Camp Sunday, August 18
th
Ages 8-12 Overnight Camp Monday, August 19
th
- Wednesday, August 21
st
Please include a recent photo of your child with your application and email a picture as an attachment to:
ashleylawtonics@gmail.com
You will be contacted in the beginning of August with further information.
Child's Name
Preferred Name
School Grade as of Fall 2024
Age
Birth Date
Gender
School Attended
Parent/Legal Guardian
Relationship
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
E-Mail Address
Do You Have Any Dietary Restrictions?
Gluten Free
Lactose Free
Vegetarian
Nut Allergies
Please Note: Per USDA and NYS Health Department Regulations, Please Do Not Bring In Your Own Food. If Your Child Has Dietary Restrictions, Food Options Will Be Made Available.
Childs T-Shirt Size (Select One):
Child Small (6-8)
Child's Medium (10-12)
Child's Large (14-16)
Adult Small
Adult Medium
Adult Large
Adult XL
Please List Your Child's Religious Affiliation (If Any):
Has Your Child Ever Spent The Night Away From Home?
Does Your Child Have Any Sleep Problems (i.e. Sleepwalking, Bedwetting, Nightmares)?
Please List Any Additional Information (Problems With Eating, Getting Along With Friends/Peers Or Family Members, School Attendance, Physical Limitations, Etc.):
Please List Any Sports/Interests/Hobbies That Your Child Has:
Please List Your Child’s Favorite Food/Snacks:
Camp Waves of Hope Bereavement History
Who Was The Person Or Persons Who Died (Name)?
How Was The Person Related To The Child?
What Was The Cause Of Death?
Age Of Your Child When The Death Occurred
Where Did This Person Die?
Was The Child Present At The Time Of Death? Explain Circumstances.
Did The Child Attend The Funeral/Memorial Service? What Was Your Child's Reaction To/Or Comments About The Service?
How Did Your Child Grieve?
Has Your Child Received Any Professional Support (i.e. School Counselor, Peer Support Group, Psychologist, Psychiatrist, Pastoral Counselor, Social Worker or Mental Health Counselor)?
Yes
No
If Yes, Is Support Currently Being Provided?
Yes
No
If Counseling Is No Longer In Progress, How Long Was The Period Of Support Provided?
Please Explain How Your Child Indicates That He/She Is Grieving.
Have There Been Multiple Deaths Of Loved Ones Experienced By This Child? If Yes, Please Describe The Nature Of Death And The Child's Relationship To The Other Person Who Died.
Camp Waves of Hope Health History Form
Camper's First Name
Camper's Last Name
Home Address
Date Of Birth
Age
Gender
Child's Height
Child's Weight
Parent/Guardian's Name
Parent/Guardian's Phone
Emergency Contact
Emergency Contact's Phone
Emergency Contact's Relationship to Camper
Alternate Emergency Contact
Alternate Emergency Contact's Phone
Alternate Contact's Relationship to Camper
Information about your child's health history is to insure his/her safe stay at Camp. Child will not be allowed to come to camp unless he/she has
all
vaccinations and/or booster.
Give date (month and year) of last vaccination for each listed:
Please list dates in the box below for each of the following: Polio, Diphtheria, Rubella, Mumps, Tetanus, Measles
Covid Vaccine (Not Mandatory To Attend Camp)
Health History (Check Those That Apply):
Attention Deficit Disorder ADD/ADHD
Constipation/Diarrhea
Diabetes
Depression
Fainting
Hearing Impairment
Menstrual Cramps
Nightmares
Hay Fever
Wears Contact Lenses/Glasses
Developmentally Delayed
Asthma
Bed Wetter
Pullups Provided
Convulsions/Seizures
Emotional Problems
Anxiety/Depression
Suicidal or Homicidal Ideation
Heart Disease
Kidney Disease
Hepatitis
Frequent Ear Infections
Bleeding/Clotting Disorder
Severe Reaction to Poison Ivy
Other
Severe Reaction to Insect or Bee Stings? Yes or No (Place Answer in Box Below) If Yes, is Medication Provided?
Please Explain Any Information We Need to Know to Care Safely For Your Child:
Child's Health Insurance Carrier
Effective Date
Plan Number
Group Number
Drug Allergies
Food Allergies
Other Significant Allergies
Are There Any Activities Your Child May Not Be Able To Participate In While At Camp?
Does Your Child Have Permission To Self-Administer Sunscreen And Bug Spray At Camp Waves? (Yes or No)
Child’s Physician's Name
Phone Number
Medications/Treatments
Please Include All Prescribed And Over The Counter Medications.
The Health History is correct to my knowledge. The person herein described has permission to engage in all prescribed camp activities except as noted. I give my permission, in the case of any emergency that requires hospital admittance or treatment, for the Camp Waves of Hope staff and/or emergency medical staff to care for my child and receive discharge information from the hospital until I can be contacted. Also, I give my permission for my child's picture to be taken and used for publicity purposes only.
Print Name
Signature
Date
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Friends Mailing Address
Friends of Hospice in Oswego County
P.O. Box 102
Oswego, NY 13126
Friends Office Address
3 Creamery Rd
Oswego, NY 13126
Friends of Hospice
Elena Twiss
Executive Director
Phone: 315-216-7580
