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Camper Confidential Form
(to be completed by the parent)
Hidden
Date
MM slash DD slash YYYY
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:
*
Very Independent
Independent
Average
Dependent
Very Dependent
Comments on dependency
My child makes friends:
*
Very Easily
Easily
Average
Slowly
Very Slowly
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: