Mini Camp Application

Child Information

Child's First Name*

Child's Middle Name

Child's Last Name*

Child's Date of Birth*

Child's Preferred Pronouns

Child's Gender Identity*

Child's Current Grade Level

Child's Place of Birth*

Child's Age When Adopted

Was the Child's Adoption Completed Through Spence-Chapin?*

Yes

Parent(s) Information

Parent 1 First Name*

Parent 1 Last Name*

Parent 1 Email*

Parent 1 Cell Phone*

Enter International

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

Enter International

Home Phone

Enter International

Primary Street Address*

Apartment Number

Primary City*

Primary State/Region*

Enter Region

Primary Zip Code*

Application Questions

TO BE COMPLETED BY A PARENT/GUADIAN

Day of Participation for Mini Camp

Can your child participate in snack time, and lunch time?

Medical History

TO BE COMPLETED BY A PARENT/GUADIAN

Does your child have any physical limitations or are they currently receiving treatment for any medical conditions or other challenges? If yes, please explain.*

Is your child currently on any type of medication? If yes, please explain.*

Does your child have any emotional considerations? If yes, please explain.*

Is there anything about your child's medical history or mental health that would be helpful for us to know?

Does your child have any allergies or adverse reactions to medications? If yes, please explain.*

Does your child have any dietary restrictions (include vegetarian or vegan)? If yes, please explain.*

Complete This Application

All the information provided as part of this application is true to the extent of my knowledge. I understand that submitting this application does not guarantee my child will be accepted into the program.

Applicant Signature*

Application Signed Date*

Child Participant Questions

TO BE COMPLETED BY CHILD WITH HELP OF PARENT/GUARDIAN

Is this your first experience participating in an adoptee community? Please Explain.

What are your hobbies, interests, and/or special skills?

Do you enjoy meeting new people and making new friends?

Do you feel comfortable speaking about your adoption with others? If so, with whom?

Do you know any other kids or adults who are adopted?

Is there anything else you would like us to know?

After clicking ‘Submit,’ you will be automatically redirected to the payment page to complete your Mini Camp registration.

Submit