Application Request

Camper Application Request

Please complete the information below to receive a Camp Fiesta application.
Our application will request a copy of your childs medical insurance.
All campers between the ages of 7-17 are invited.

Camper

* Indicates required field

Name *

Gender *

Age as of July 25, 2026 *

Grade as of July 25, 2026 *

Address *

State *

City *

Zip Code *

Parent/Guardian

Name *

Home Phone *

Email *

Cell Phone *

Pediatrician or Oncologist

Name *

Date of Diagnosis *

Primary Treatment Center *

Phone Number *

Date of Remission - if applicable *

Medical Insurance *

Submit

​Camper Application Request

Camper

Parent/Guardian

Pediatrician or Oncologist

OVER 40 YEARS STRONG * Summer 2026 * July 25th - August 2nd

Camper Application Request

**OVER 40 YEARS STRONG * Summer 2026 * July 25th - August 2nd**