Campers! Apply Here. – Camp Courage

Camper InformationThis is a cost-free camp for children ages 7-15 who have or have had cancer and one brother or sister. The application requires health history information. All pages must be completed before you can submit the application. All applications must be in by July 5th, 2024. Campers should not be in active treatment at the time of camp. No IV medications will be given at camp, and campers should not have central lines in place. If there is any questions about this please don't hesitate to reach out to the staff at Camp Courage at campcouragecolorado@gmail.com

Email Address *Please provide the best email address to contact you

First Name *

Last Name

Age: *

Grade This Fall Semester *

Birthday *

Gender *

T-Shirt Size *

Has your child attended Camp Courage before? If yes, how many times? *

Health Insurance And Doctor Information

Child’s Pediatrician/Doctor: *

Phone Number *

Health Insurance Information

Do you have medical insurance? *

Full Name of Policy Holder: *

Policy Holder Phone Number: *

Employer Name (if insured through company): *

Insurance Company/Plan Name: *

Insurance Company Phone Number: *

Health Insurance Policy Number: *

Insurance Group Name or Number: *

Permission for Media (Photos & Video)Permission for photographs and interviews of campers under 18 years of age can be granted to the media ONLY with parent/guardian approval. These photographs, written interview quotes and verbal interview statements will appear in information about Camp Courage programs and people. I understand that Camp Courage shall not be liable for royalties, commissions, or payments of any nature to me or my child in connection with such filming, photographing, and/or interviewing. Camp Courage assumes no liability of any nature in connection with such filming and/or interviewing. I hereby give permission to Camp Courage to allow my child to be filmed/photographed and interviewed by the media.

Select *Do you give permission to Camp Courage to allow your child/children to be filmed/photographed and interviewed by the media?

Signature of Parent/Gaurdian

Please sign if you agree to give Permission for Media (Photos & Videos)

Please Fill out all of the information requested. A copy of the form above will be emailed to you. By writing your name below you agree to the following: (Parent/Guardian)o I certify that all information on this application is true and correct. o I have informed you of any special needs that will require attention during my child’s stay at camp. o I will review the rules and guidelines of expected behavior at Camp Courage with my child before his/her time at camp. o Because there is no regularly scheduled transportation, if for any reason it is determined by the Camp Courage staff that my child must leave before the end of his/her session, I agree to be responsible for his/her transportation from Camp within 12 hours.

Signature of Parent/Guardian *

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