Camp Dates: Sunday, May 26, 2019 - Friday, May 31, 2019
It will approximately take 15-20 minutes to complete the application. You will not be able to save your work mid-way through the application, so please have the following information available prior to starting the application process:
Please note a few things:
Your application is NOT considered complete until ALL sections are filled out/signed and all applicable documents are uploaded.
Suggestion: Please download/print the Primary Treating Physician Form and have your child's PCP complete it before starting this application (see link below). Otherwise, complete this application and email a scanned copy to firstname.lastname@example.org. The application will not be considered completed without the assessment.
To apply to participate in Camp Reynal, the parent or legal guardian must complete and return this Application Packet. The Application Packet must include:
A complete and accurate Camper Application, containing all required information and attachments signed by the applicant’s parent or legal guardian.
A Completed Medical Background Form.
An Acknowledgement of Behavior Policy Form signed by the applicant and parent or legal guardian.
A Conditions of Participation Form signed by the applicant’s parent or legal guardian.
An Assessment by Primary Treating Physician Form, completed and signed by Physician.
CLICK HERE TO OBTAIN THE FORM
*Cooks patients* Please disregard this step since your nephrology nurse will complete this form on your behalf.
A copy of the applicant’s current health insurance card or other documentation of the applicant’s enrollment in health insurance coverage.
A picture of the applicant for identification purposes.
Are you ready to begin? Click next!