Application Request

Camper Application Request

Please complete the information below to receive a Camp Fiesta application packet. In order to attend Camp Fiesta your child must be medically insured and between the ages of 7-17.

Camper

* Indicates required field

Name *

Gender *

Age as of July 22, 2023 *

Grade as of July 22, 2023 *

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 2023 * July 22nd - July 30th * Ages 7-17 are all welcome

Camper Application Request

**Summer Session 2023 * July 22nd - July 30th * Ages 7-17 are all welcome**