Open Hearts Camp
2023 Aplication
Session One: Ages 11-12. Sunday, June 25 to Friday, July 7
Session Two: Ages 13-14. Sunday, July 9 to Friday, July 21.
Session Three: Ages 15-16. Sunday, July 23 to Friday, August 4.
Session Four: Ages 8, 9, 10. Sunday, August 6 to Tuesday, August 15.
Camper's Name
(required)
Camper's Preferred Nickname
Address
(required)
Age (at camp Summer 2023)
(required)
8
9
10
11
12
13
14
15
16
Date of Birth
(required)
Sex
(required)
Female
Male
Number of years at the Open Hearts Camp
(required)
Name of Parent(s) or Guardian(S)
(required)
Phone Numbers
(required)
Email address
(required)
Address
(required)
Please indicate according to AGE the camp session in which you wish to enroll your child.
(required)
Session One: Ages 11-12. Sunday, June 25 to Friday, July 7
Session Two: Ages 13-14. Sunday, July 9 to Friday, July 21
Session Three: Ages 15-16. Sunday, July 23 to Friday, August 4
Session Four: Ages 8, 9, 10. Sunday, August 6 to Tuesday, August 15
Cardiologist Name
(required)
Address
Email address
Phone Number(s)
(required)
Please give a brief summary of child's cardiac diagnosis and present health:
(required)
Yes, I authorize the use of photographs/video of my child while at camp for promotional purposes only.
yes
Type the characters
(required)
Send
This field should be left blank
Open Hearts Camp
Open Hearts Camp
