2025-26 Virtual Young Teen Asthma & Wellness Camps (VYTAWC) Camper Interest Form (ages 11-15) & Asthma Blues Mini-Camp Registration (all ages, parents welcome!)

Parent/Camper Information

Name

Age of camper

Home (Mailing) Address

City/Town/Zip code (if Different)

Zip/Postal Code

Gender

School Email Address

Parent/Guardian Email Address

Phone Number

For More Information or to discuss, contact Ellen Buckner, ebbuckner@gmail.com (205) 910-9877.

Asthma Blues Mini-Camp (all ages, parents welcome!)

Virtual Young Teen Asthma & Wellness Camp (ages 11-15, 1-week, dates TBA).

Leader-in-Training Program (ages 15-18) (Virtual, Dates TBA).

Saturday September 13, 10:00-11:30 AM (Central Time) on Zoom

Saturday October 11, 10:00-11:30 AM (Central Time) on Zoom

Saturday November 8, 10:00-11:30 AM (Central Time) on Zoom

Saturday December 13, 10:00-11:30 AM (Central Time) on Zoom

Other (please specify)