1st Quarter Respite Registration 2017

Question Title

* 1. Camper First and Last Name
Please double check spelling before submitting.

Question Title

* 2. Have you sent in your...
we must have all of these items before you can fill out this form

Application

Immunization Records and Health History Form

Physical (valid for 2 years)

3 Signed Waiver Forms (located in the application)

CCSP or ICP from your case manager

Funding (Notice of Decision or private payment)

Question Title

* 3. Please enter in your case managers email address

Question Title

* 4. Please choose the 1st Quarter respite sessions you would like to request
(2nd quarter dates will open March 2nd)

R1 January 6-8 Camp Sunnyside's Got Talent

R2 January 20-22 Fantasy Land

R3 February 3-5 Valentines

R4 February 17-19 Up, Up, and Away (Superheroes)

R5 March 3-5 Amazing Race

R6 March 24-26 Camp Sunnyside Olympics

By submitting this form, you understand that this is a request for the dates listed and NOT a confirmation that you have been registered. You will receive a letter in the mail that will show whether you have been confirmed or added to the waitlist.

Question Title

* 1. Camper First and Last NamePlease double check spelling before submitting.

Question Title

* 2. Have you sent in your...*we must have all of these items before you can fill out this form*

Question Title

* 3. Please enter in your case managers email address

Question Title

* 4. Please choose the 1st Quarter respite sessions you would like to request(2nd quarter dates will open March 2nd)

* 1. Camper First and Last Name
Please double check spelling before submitting.

* 2. Have you sent in your...
we must have all of these items before you can fill out this form

* 4. Please choose the 1st Quarter respite sessions you would like to request
(2nd quarter dates will open March 2nd)