3rd Quarter Respite Registration 2019 3rd Quarter Respite Registration 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* 2019 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) Case manager's email address Question Title * 3. Please choose the 3rd Quarter respite sessions you would like to request R13 Stars and Stripes (July 5-7) R14 Color War (July 19-21) R15 Blast off! (August 9-11) R16 Camp Sunnyside Luau (August 23-25) R17 Myth Busters (September 6-8) R18 Wild West (September 20-22) 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 * 4. Person filling out survey? Case Manager Guardian Other (please specify) Submit