Camper Confidential Form - Christian Camps & Conferences

(to be completed by the parent)

Hidden

Date

Camper's Name*

First

Last

Date of Birth*

Current Grade*

Father's Name*

First

Last

Father's Occupation*

Mother's Name*

First

Last

Mother's Occupation*

Who lives at home?*

Father
Mother
Sibling
Other/Grandparent

Name of Sibling 1*

Age of Sibling 1*

Name of Sibling 2

Age of Sibling 2

Name of Sibling 3

Age of Sibling 3

Name of Sibling 4

Age of Sibling 4

If divorced or legally separated, who has custody?

To Whom may your child be released?

Church Affiliation

Has your son / daughter previously been to camp?*

Yes
No

How long?

Name of Camp

What fears, if any, does your child have?*

Is your child oversensitive?*

Yes
No
Sometimes

If so, in what way?*

Camper's Sleeping Habits:*

Light
Heavy
Sleepwalks
Nightmares
Bet wets
Just Fine
All of the above!

Socializing qualities (mixing, group living, etc.)*

Below Average
Average
Above Average

Comments on socializing ability

My child is:*

Comments on dependency

My child makes friends:*

Comments on making friends

Has your child had previous group experiences outside of school?*

yes
no

Which of these?

Clubs
Scouts
Other

Were these good experiences?

My child's religious interests are:*

Little
Some
Much
Very Much

Religious Interest Comments

We are sending our child to camp for the following reasons:*

(check as many as apply)

A summer vacation
Learn to further appreciate the outdoors
To experience camping as you know it
To be part of the positive atmosphere at a Christian camp
An experience in group living
To learn new skills
To have a variety of experiences
For a special reason

What is your special reason for sending your child to camp?

Please list special talents or interests that your child shows evidence of having:

What does your child do with most of his/her spare time?*

What kind of problem, if any, are the counselors most likely to have with your child at camp?

Has your child had psychological counseling?*

Yes
No

if so, for how long and for what purpose?

Additional information or comments, if any:

These questions answered by:*

Relationship to camper:*

Signature: