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.
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.
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.
✓ 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)
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