2020 Application

Session One, 11-12 year olds, June 28 to July 10

Session Two, 13-14 year olds, July 12 to July 24

Session Three, 15-16 year olds, July 26 to August 7

Session Four, 8, 9, 10 year olds, August 9 to August 18

Camper's Name(required)

Camper's Preferred Nickname

Address(required)

Age (at camp Summer 2017)(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, 11-12 year olds, June 28 to July 10

Session Two, 13-14 year olds, July 12 to July 24

Session Three, 15-16 year olds, July 26 to August 7

Session Four, 8, 9, 10 year olds, August 9 to August 18

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