BAA Camp Application Form
 



District Name:   School Name:

Camp Be An Angel is designed to be a retreat for special needs children under the age of 22 and their immediate families (Mom, Dad, Brothers and Sisters).

Two camps will be offered this coming school year. Please check the box next to your preferred date:

September 15-17, 2017

Attendance is free of charge and families are selected on a needs basis with priority being given to first time campers. Selectees will be sent a letter of commitment. You will need to arrange for your own transportation; however you will receive a $25 gas card when you arrive.
ALL spaces must be filled in. If a space doesn't apply, enter N/A.

Parent or Guardian First Name of special needs child Parent or Guardian Last Name of special needs child
Address: City: State: Zip:
Preferred Phone: - -    Email:
HANDICAPPING CONDITION:
Please select all that apply from dropdown list at the right.




Is a wheelchair or walking assistance required? Yes    No
Is there difficulty sleeping through the night? Yes    No

Would they disturb other campers?
Please explain

Any dietary Restrictions?

Any other special considerations?

Previous camp attendance

How did you hear about camp BAA?

What financial assistance do you receive?

Please list all immediate family members (a maximum of 7) who will be attending -
including the child listed above:
(at least one parent/legal guardian must be in attendance)
First Name Last Name Age Relationship Gender TshirtSize

Thank you for your participation.