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2018 Camper Application & Parent Information

Camp Candlelight Dates:
Sunday, June 3rd – Saturday, June 9th 2018  
Location: Sky-Y Camp | 5725 S. Senator Hwy | Prescott, AZ 86303

PAYMENT OPTIONS INCLUDE: 

  • ONLINE  – CLICK HERE TO PAY ONLINE -NOTE: Please have patience while you’re automatically navigated to online payment site.
  • CHECK (kindly make out to: Epilepsy Foundation of Arizona with “Camp Candlelight” in the notes)
  • CASH/MONEY ORDER (in-person delivery MUST be pre-scheduled, please email info@epilepsyaz.org to set-up a time for this)

NOTE: ALL PAYMENTS MUST BE MADE UPON SUBMISSION OF YOUR CAMP APPLICATION. IF THE CHILD IS UNABLE TO ATTEND, A FULL REFUND OF THE CAMP FEE WILL BE PROVIDED.

ANY APPLICATIONS SUBMITTED PAST 5/14/18 WILL INCUR AN ADDITIONAL $50.00 LATE FEE.

REGULAR Camp Application DEADLINE: SATURDAY, APRIL 14, 2018 – FRIDAY, MAY 14, 2018.

(THERE ARE 3 PARTS* TO THE APPLICATION PROCESS + $550.00** CAMP FEE, PT. 1 & 2 MUST BE SUBMITTED NO LATER THAN 5/14/18.)

*WE UNDERSTAND PT. 3 (PHYSICAL EXAM) MAY TAKE LONGER BUT IT MUST BE SUBMITTED SOME TIME BEFORE CAMP BEGINS OR THE CHILD WILL NOT BE ADMITTED.

NEW POLICIES:

  • THE REGISTRATION FEE (LISTED ABOVE) MUST BE SUBMITTED WITH APPLICATION. REFUNDS WILL BE PROVIDED IF THE CHILD IS INELIGIBLE.
  • ANY APPLICATIONS SUBMITTED PAST 5/14/18 WILL INCUR AN ADDITIONAL $50.00 LATE FEE.
  • A RECENT PHOTO IS REQUIRED OF ALL CAMPERS FOR SECURITY PURPOSES.

THERE ARE 3 PARTS TO THIS APPLICATION – PT. 1 & 2 MUST BE COMPLETED/SUBMITTED BY DEADLINES ABOVE & PT 3 MUST BE SUBMITTED BEFORE CAMP AT SOME POINT OR YOUR CHILD WILL NOT BE ADMITTED.

  • PART 1: GENERAL CAMPER INFO APP (COMPLETE/SUBMIT ONLINE)

Part 1 CAMPER APP

  • PART 2: CAMPER MEDICAL INFO APP (Upon completion of part 1, you will need to download the pdf for part 2, complete/submit via mail or scan/email)

IMPORTANT: 

⇒BEFORE FILLING OUT, DOWNLOAD AND SAVE ONTO DESKTOP.

⇒UPON COMPLETION ENSURE YOU “SAVE AS” UNDER A DIFFERENT FILE NAME OR NONE OF THE COMPLETED FORM FIELDS WILL SAVE AND ALL WILL APPEAR BLANK.

Part 2 CAMPER APP

  • PART 3: CAMPER PHYSICAL FORM APP (Upon completion of part 2, you will need to download the pdf for part 3, and have your child’s neurologist or primary care physician complete/submit via mail or scan/email)

IMPORTANT: 

⇒BEFORE FILLING OUT, DOWNLOAD AND SAVE ONTO DESKTOP.

⇒UPON COMPLETION ENSURE YOU “SAVE AS” UNDER A DIFFERENT FILE NAME OR NONE OF THE COMPLETED FORM FIELDS WILL SAVE AND ALL WILL APPEAR BLANK.

Part 3 CAMPER APP

Complete Application Checklist:

✓ Camp Candlelight Application (Online) Part 1 of App
✓ Signed Release/Consent Form
✓ Medication List & Schedule
✓ Over the Counter Medication Permission
✓ Copy of Health Insurance Card
✓ Behavior Expectation Form
✓ Physician’s Physical Exam Card (Part 3 of App)
✓ Registration Fee – see amounts listed above ($35.00 Scholarship Fee, IF APPLICABLE – This is non-refundable.)
✓ Recent photo of camper (during 2017-2018)

2018 PARENT INFO DOC
2018 PACKING CHECKLIST

APPLICATION SUBMISSION OPTIONS:

MAIL TO:
Epilepsy Foundation of Arizona
Attn: Camp Candlelight
3620 N. 4th Ave. Rm, #228
Phoenix, Arizona 85013

OR SCAN & EMAIL TO:
E-mail: info@epilepsyaz.org
Subject: [CHILD’S NAME] Camper App 2018

***WE DO NOT HAVE A FAX MACHINE***

[No child will be able to attend camp unless ALL applicable documentation is complete and payment(s) processed. ALL CHILDREN MUST HAVE HEALTH INSURANCE TO BE CONSIDERED.

We hope you will consider this as an opportunity to provide your child with a wonderful and enriching experience. We will be in touch with you soon!

Sincerely,
Suzanne Matsumori,
Executive Director, Epilepsy Foundation of Arizona