Confidential Information
For your child's counselor
Name of camper
*
First Name
Last Name
Session(s) Attending:
*
Junior Camp
Young Teen Camp
Equestrian 1
Equestrian 2
Equestrian 3
Equestrian 4
Cowgirl 1
Cowgirl 2
Adventure Camp
Guy Stuff Camp
Grade in Fall 2025
*
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Dad
Name
Occupation
Mom
Name
Occupation
Persons in the home:
*
Dad
Mom
Step-Father
Step-Mother
Brothers
Sisters
Others
Has your child been away from home more than two days?
*
Yes
No
Has your child been away from home for more than a week?
*
Yes
No
Child's responsibilities at home
*
Child makes friends with children
*
Own age
Younger
Older
Child takes a long time making friends
*
Yes
No
Church of Youth Group your child attends
What experiences would you like your child to have at camp?
*
What does your child want to receive from his/her camp experience?
*
Behavior
*
Hardly
Ever
Some of
the time
Almost all of
the time
Finishes what he starts
Listens to instructions
Teamwork
Moody
Tends to lead
Positive attitude
Teases others
Obeys rules
Sleep Habits
Light sleeper
Heavy sleeper
Bed wetter
Sleepwalker
Nightmares
Food or activity restrictions
*
Special needs or comments. (Please be detailed. The counselor will not see the nurse's medical history form. Please medical concerns the counselor should know.)
*
Submit
Should be Empty: