Application Request

Camper Application Request

To receive an application to attend Camp Fiesta the camper must be medically insured and between the ages of 7-17. Please complete the following information:

Camper

* Indicates required field

Name *

Gender *

Age as of July 24, 2020 *

Grade as of July 24, 2020 *

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

Summer Session 2020 July 25th - August 2nd

Camper Application Request