Copy of Youth Haven Summer Camp Interest Form July 31 - August 4, 2023

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* 1. First and last Name ( Guardian/Parent or your name if you are over 18)?

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* 2. Email?

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* 3. Phone Number?

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* 4. Alternate Contact Information?

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* 5. Are you a District of Columbia resident?

Yes

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* 6. What is your street address?

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* 7. How many young people are you interested in registering to camp?

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* 8. How did you hear about the Youth Development and Wellness program?

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* 9. Participant age(s)?

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* 10. Participant School Level/Grade?

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* 11. Comments, questions & concerns?

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* 12. Are you interested in volunteering as a Camp Counselor?

Yes

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* 13. Are you interested in donating? (gift cards, toiletries, swim gear etc)

Yes

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* 14. Which of the programs do you want to be a part of? ( check all that apply)

Be Well Retreat (Age 16-24) This is a retreat dedicated to supporting young people who have been diagnosed with HIV by dispelling stigma through wellness education. Enjoy wellness workshops, arts, team building, and discussion groups.

Youth Haven Kids Camp (Age 7-18) This is an overnight camp focused on improving leadership skills, building healthy emotional habits, and forming lifelong bonds via games, crafts, and adventure activities.

Love Notes (Age 14-19) This program focuses on building healthy relationships. The knowledge tips and skills in this program will help you be more successful in love, life and work.