2012 Camp Cara Application 

Please fill out the form completely.  Items marked with * are required to complete the application process. 


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Camp Cara Application
* Participant Name
* Age
* Primary Contact
* Email Address:
* Daytime Phone #
* Do you receive services from Hope?Yes No
   Who is your care coordinator or Family Matters Representative?
   Who is your supervisor?
* What services do you receive from Hope? Select all that apply.
* Do you utilize a wheelchair or a walker?Yes No
* What method of payment would you be using?
   I would like to participate in the following weekly camps:
   I would like to participate in the following day camps:

Once your application has been received and accepted to Camp Cara, you will be asked to fill out the Camper Registration Packet that is required by all participants.    

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