Camp Ford: Camper Application 2012 APPLICATION Learn leadership skills, sleep under the stars, see wildlife, play volleyball, get to know others, get to know yourself, raft the Klamath River, sleep under the stars, hike to Ukonom Falls, perform skits, learn the natural history of the area, eat great food, share stories by the campfire, find quiet time, do a service project, and live without your cell phone and ipod! Question Title * 1. First and Last Name: Question Title * 2. Gender Male Female Question Title * 3. Contact Information: Address: City: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Cell Phone: Home Phone: Question Title * 4. Email Address: Question Title * 5. Parent/Guardian: Name: Phone Number: Email Address: Question Title * 6. What grade will you be entering in the fall of 2012? Question Title * 7. What High School will you be attending? Question Title * 8. What Middle School did you attend? Question Title * 9. Date of Birth: mm/dd/yyyy Date Question Title * 10. How did you learn about the camp? Question Title * 11. Are you available to attend the entire camp from July 29th - August 4th? Yes No Question Title * 12. What are some of the things you like to do (for example: hobbies, clubs, sports, family life, and personal interests) and that you'd like to share with other campers? Question Title * 13. What issues or opportunities do you see in your community to make it a better place to live, study and play? Question Title * 14. What are some of your best leadership qualities? Question Title * 15. What are you expecting to get out of Camp Ford? Question Title * 16. Have you ever attended overnight camp before? Yes No If so, which one? Question Title * 17. Have you ever been white-water rafting? Yes No Question Title * 18. Can you swim? Yes No Question Title * 19. Do you have any medical or physical conditions that would affect your ability to hike and raft? Please submit two letters of reference. One must be from a teacher or principal, and the other can be from any adult, not related to you, and who has known you for at least a year. Forms can be downloaded at www.tfff.org/campford and are due by April 20th, 2012.Please return your completed letters of reference to :Brady SvilichSiskiyou Family YMCA350 N Foothill DriveYreka, CA 96097 Done