Please Note: Referral Partners must complete this form. A recommending party can be a teacher, physician, therapist, social worker, pastor, etc.

Please provide detailed information as to this child's strengths and weaknesses and/or coping mechanisms. Their specific camp counselors will be reviewing this form prior to their arrival at camp in order to best serve the camper in regards to our character development programming.


1) Complete this form. Simple!

2) Contact the parent/ guardian of the child you are recommending so they are aware of their recommendation. Jameson Camp may also contact the family, but only if you, the recommending partner, grant permission.

The family may learn about camp by visiting www.jamesoncamp.org, emailing questions to registrar@jamesoncamp.org, or calling 317-241-2661. AN APPLICATION FORM MUST BE COMPLETED OUT IN ORDER TO REGISTER FOR CAMP.

CONFIDENTIALITY STATEMENT: The information you provide to us is confidential and will only be used to become familiar with the child we serve and to establish goals for the child while at camp. Information will not be released to a parent. The principle of confidentiality is maintained in all programs, functions, and activities.
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