Grade camper will be entering in fall 2021. * 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
Troop Leader's Name or Troop Number (if applicable)
Service Unit Name or Service Unit Number (if applicable)
County *
Cell Phone *
Home Phone
Email *
Other Parent Cell Phone
Emergency Contact Phone Number *
Camper age when starting camp 6 7 8 9 10 11 12 13 14 15 16 17 18
If other, please explain.
Name and phone number of family physician *
Name and policy/group number for medical/hospital insurance carrier. *
Were there any medical diagnoses made at the time? *
List any camper allergies *
If other, please explain.
Please explain
Please explain
Please note:
Please explain any "yes" answers in detail - or add in any information about the camper's health you think is important or that might affect the camper's ability to fully participate in the camp program.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
Name of medication, date medication started, reason for taking, when medicine is taken, amount/dose given, how it is given.
By typing my full name below I agree that all of the information submitted in this form is correct and up to date. If I need to make any changes I will contact camp staff immediately at residentcampforsoca@gmail.com. *
Choose ONE program option for your camper to attend. * Daisy (entering 1st grade) - Taste of Camp - July 11-13 Full. Waitlist only. Brownie (entering 2nd or 3rd grade) - Taste of Camp - July 11-13 Full. Waitlist only. Brownie (entering 2nd or 3rd grade) - Fairytale Fun - July 18-23 Junior (entering 4th or 5th grade) - Giddy Up - July 11-16. Full. Waitlist only. Junior (entering 4th or 5th grade) - Giddy Up - July 18-23 - Full. Waitlist only. Junior (entering 4th or 5th grade) - Craftastic - July 11-16 Full. Waitlist only. Junior (entering 4th or 5th grade) - Under the Sea - July 18-23 Junior (entering 4th or 5th grade) - Magician's Essentials - July 11-16 Cadette/Senior (entering 6th - 10th grade) - Hogsmeade Summer Retreat - July 11-16 - Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Horsin' Around - July 11-16 - Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Horsin' Around - July 18-23 Cadette/Senior (entering 6th - 10th grade) - Me, Myself and Art - July 11-16 Cadette/Senior (entering 6th - 10th grade) - Roughin' It - July 18-23 Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Float Your Boat - July 18-23 Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Bon Appetit - July 18-23 Cadette/Senior (entering 6th - 10th grade) - Adventure Out - July 11-23 Cadette/Senior (entering 6th - 10th grade) - Back in the Saddle - July 18-23 Senior/Ambassador (entering 9th - 12th grade) - River Rats - July 11-23 Senior/Ambassador (entering 10th - 12th grade) - Counselor in Training (CIT) 1 - July 11-23 Ambassador (entering 11th - 12th grade) - Counselor in Training (CIT) 2 - July 11-23 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 11-16 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 18-23 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 12 - 17 & July 18-23
Choose one ALTERNATE program option for your camper to attend in the event your program choice is full. (copy) * Daisy (entering 1st grade) - Taste of Camp - July 11-13 Full. Waitlist only. Brownie (entering 2nd or 3rd grade) - Taste of Camp - July 11-13 Full. Waitlist only. Brownie (entering 2nd or 3rd grade) - Fairytale Fun - July 18-23 Junior (entering 4th or 5th grade) - Giddy Up - July 11-16 Full. Waitlist only. Junior (entering 4th or 5th grade) - Giddy Up - July 18-23 - Full. Waitlist only. Junior (entering 4th or 5th grade) - Craftastic - July 11-16 Full. Waitlist only. Junior (entering 4th or 5th grade) - Under the Sea - July 18-23 Junior (entering 4th or 5th grade) - Magician's Essentials - July 11-16 Cadette/Senior (entering 6th - 10th grade) - Hogsmeade Summer Retreat - July 11-16 - Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Horsin' Around - July 11-16 - Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Horsin' Around - July 18-23 Cadette/Senior (entering 6th - 10th grade) - Me, Myself and Art - July 11-16 Cadette/Senior (entering 6th - 10th grade) - Roughin' It - July 18-23 Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Float Your Boat - July 18-23 Full. Waitlist only. Cadette/Senior (entering 6th - 10th grade) - Bon Appetit - July 18-23 Cadette/Senior (entering 6th - 10th grade) - Adventure Out - July 11-23 Cadette/Senior (entering 6th - 10th grade) - Back in the Saddle - July 18-23 Senior/Ambassador (entering 9th - 12th grade) - River Rats - July 11-23 Senior/Ambassador (entering 10th - 12th grade) - Counselor in Training (CIT) 1 - July 11-23 Ambassador (entering 11th - 12th grade) - Counselor in Training (CIT) 2 - July 11-23 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 11-16 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 18-23 Ambassador (entering 12th grade) - Camp Staff Intern (CSI) - July 12 - 17 & July 18-23
Want to bunk with a friend? Add their name below. ONE name only. Please be sure your friend requests you also.
Please enter the amount you would like to pay ($25 minimum)
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