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Asthma Blues Mini-Camp 2025 Registration
Parent/Camper Information
1.
Please enter
Name of Mini-Camp Participant
and his/her/their contact information (Please use a separate surveys for each camper). Recommended for campers 6-18 years.
Name
Age of camper
Camper Email Address
Home or Mailing Address
City/Town
Zip/Postal Code
Gender
Camper's School Email Address
Parent/Guardian's Email Address
Phone Number
2.
Please enter name of parent/guardian, relationship, and contact information.
Name
Relationship
Email Address
Alternate Email
City/Town
ZIP/Postal Code
County of residence
Parent/Guardian Cell Phone Number
Alternate Phone number
Which do you prefer: Call by phone (cell) or Text (cell).
3.
What is your camper's School & current Grade?
4.
Mini-Camp Session Interest: The Mini-Camp is a virtual interactive camp, held the second Saturday of the month (online) from 10:00-11:30 AM (Central Time). Campers receive the digital music to download prior to camp. Camper may attend multiple camps. Check all that apply.
September 13, 2025
October 11, 2025
November 8, 2025
December 13, 2025
List any alternate or preferred dates available:
5.
Has parent/camper received any form of asthma education from a provider or clinic? If so, please describe.
6.
What challenges or problems about asthma would you like to have addressed?
7.
Do you have any other questions about the camp? Thank you for your interest!
Current Progress,
0 of 7 answered
