Champions Kids Camp Camper Application

Champions Kids Camp 2024 Camper Application

Please Read ALL Application Instructions
Champions Kids Camp is a camp for children who have survived a traumatic illness, injury, or complex trauma, including the loss of a parent or sibling. Children must be between the ages of 8 and 12 to attend camp. Siblings of the child who has experienced the trauma (ages 8 to 12) may attend camp.

Camp is provided at no charge to all campers.

Please fill out each section of the application completely. We will email you all the necessary medical forms, maps, and clothing list prior to camp.

If you have any questions or concerns, please call Champions Kids Camp at 832-449-3743, email at info@championskidscamp.org, go to our website at www.championskidscamp.org, or write us at:

NEW Address:

Champions Kids Camp

9711 S. Mason Rd., Ste 125, Box 305

Richmond, TX 77407

Please notify us if your address, phone number, or e-mail changes. Without up-to-date information, your child may miss the opportunity to attend Champions Kids Camp.

The signature of a parent or guardian must be on this application.

Recent photo of your child must be included to be considered.

Important dates:

            Application due – May 31, 2024

              NEW DEADLINES

Completed medical forms (If accepted, we will mail forms (5) to you or send you a secure link via email) - June 20, 2024

            CAMP DATES – July 14 - 19, 2024

Carolina Creek Christian Camp

84 Wimberly Lane, Huntsville, TX (30 mins from Conroe)

Keep this information – You will need it later!!!

Please be aware: For the safety of your child and others, they will be required to follow instructions and treat their group leaders with respect at all times. Also, if your child should repeatedly exhibit any unacceptable behavior at camp, such as bullying, name calling, using vulgar language, or physical aggression that can impact their fellow campers’ positive camp experiences, and refuses to stop such behavior, you WILL be called and REQUIRED to pick him/her up within 2 hours. Parent/Guardian must be available during this week if needed.

Camper Information
Camper Name*

First NameLast Name
Likes to be called
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Please select one*

MaleFemale
Age as of January of this year*
Grade as of January of this year*
Former Camper?*
If Yes, list years attended
T-Shirt Size*
Please keep in mind what size your child might be at the time of camp in July
Dress Size (for Female Campers
Is camper the child of an active military, veteran, or first responder?*

YesNo
Please provide us with a detailed & concise statement of camper’s serious illness, injury, or trauma. This is essential to determining their eligibility for camp. *

Camper Photo
A photo is required, so that we can easily identify your child at camp (if accepted). You can upload a recent photo, or take a photo with your device. The form will not submit without one or the other completed.
Upload a recent photo of your child

Browse Files

Cancelof
or Take Photo

Parent or Guardian Information (primary)
Parent/Guardian Name (primary contact)*

First NameLast Name
Relationship to Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Email*
example@example.com

Parent or Guardian Information (secondary)
Parent/Guardian Name

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Email
example@example.com

Alternate Contacts
The alternate contact person must be eligible to pick up camper if parent is unavailable and the circumstance arises.
Alternate contact person*

First NameLast Name
Relationship To Child*
Phone*

Area CodePhone Number
Alt Phone

Area CodePhone Number
Therapist's Name (if applicable)

First NameLast Name
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Social Worker's Name (if applicable)

First NameLast Name
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number

Sign and Submit Application
The above information will be helpful to guide your child to enable healing and assure an enjoyable camp experience. Our goal at Champions Kids Camp is to provide a safe and healing environment for each child to get passed what they will never get over.

Please review your responses in all sections above. When you are ready, please sign below and submit your child's application.
Signature of Parent or Guardian*

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Champions Kids Camp 2024 Camper Application

Recent photo of your child must be included to be considered.

Application due – May 31, 2024

CAMP DATES – July 14 - 19, 2024

Keep this information – You will need it later!!!