Summer Camp Registration

Oncology Summer Camp

For kids with cancer and their siblings, ages 6-16.
Welcome to Happiness Is Camping's application! This application form is for Oncology Summer Camp. Summer Camp is for kids with cancer and their siblings, ages 6-16. Summer Camp dates are as follows:
- Session 1: July 2 – 6
- Session 2: July 9 – 13
- Session 3: July 16 – 20
- Session 4: July 23 – 27
I acknowledge that I am registering a child with cancer between the ages of 6-16 for overnight Summer Camp.*

Yes

Camper Information

"Camper" means your child with cancer.
What is your Camper's name (aka the name of your child with cancer)?

First NameLast Name
When was {CamperName:first} born?*

MonthDayYear
Date
{CamperName:first} is a:*

MaleFemale

Cancer Diagnosis Information

This section will gather some info regarding your Camper's cancer diagnosis.
We're so excited that {CamperName: first} wants to join us for Summer Camp! Please tell us a little bit about their cancer diagnosis.
Cancer Diagnosis*
Date of Diagnosis*

MonthDayYear
Date
Is {CamperName:first} on active treatment?*

YesNo
Date of last treatment.*

MonthDayYear
Date
Name of {CamperName:first}'s home hospital/treatment center.*
Name of Doctor (Oncologist or Pediatrician)*
Child Life Specialist/Social Worker's Name
Name of Child Life Specialist/Social Worker your child works with, if applicable.
Child Life Specialist/Social Worker's Email
example@example.com

Parent/Guardian Information & Emergency Contact
This is the final step! Please add any relevant parent/guardian contact information and include at least one emergency contact.
Parent/Guardian 1 Name*

First NameLast Name
Relationship to Child with Cancer?*
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number (Mobile)*
Please enter a valid phone number.
Parent/Guardian 1 Phone Number (Home)
Please enter a valid phone number.
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a second parent/guardian?*

YesNo
Parent/Guardian 2 Name*

First NameLast Name
Relationship to Child with Cancer?*
Parent/Guardian 2 Email*
example@example.com
Parent/Guardian 2 Phone Number (Mobile)
Please enter a valid phone number.
Parent/Guardian 2 Phone Number (Home)
Please enter a valid phone number.
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

Please note: Emergency Contact MUST be different from parent/guardian.
Emergency Contact Name*

First NameLast Name
Relationship to Camper*
Emergency Contact Phone Number (Mobile)*
Please enter a valid phone number.
Emergency Contact Phone Number (Home)
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add a second Emergency Contact?*

YesNo
Emergency Contact 2 Name*

First NameLast Name
Relationship to Camper*
Emergency Contact 2 Phone Number (Mobile)*
Please enter a valid phone number.
Emergency Contact 2 Phone Number (Home)
Please enter a valid phone number.
Emergency Contact 2 Email
example@example.com
Emergency Contact 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Paperwork Requirements
Mandatory paperwork must be submitted by June 1. Please be advised that registration is not 100% complete until all mandatory paperwork has been uploaded. A member of the HIC Staff will email you with instructions to upload required paperwork.

Paperwork Requirements to Attend

Child with Cancer:
- Health Form (Child with Cancer)
- Health History Form
- Insurance Card (Front and Back)
- COVID-19 Card
Siblings:
- Health Form (Sibling)
- Health History Form
- Insurance Card (Front and Back)
- COVID-19 Card
If you have them readily accessible, you can upload any of these files here. Please note that this is not required at this time.

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Cancelof
I agree to upload all required paperwork by June 1.*

Yes
Please verify that you are human*
Should be Empty:

Oncology Summer Camp

Camper Information

Cancer Diagnosis Information

Sibling Registration

COVID-19 Requirements

Session Selection

Summer Camp Dates:

Parent/Guardian Information & Emergency Contact

Emergency Contact Information

Paperwork Requirements

Paperwork Requirements to Attend

Child with Cancer:

Siblings: