Joe's Camp: Family Day Registration

Date: August 9-11, 2019

Location: Camp Canaan, Rock Hill, SC

Check In: 10:00 AM, Sunday
Check Out: 3:00 PM, Sunday

Please complete the following information for those in your family interested in attending the Joe’s Camp Family Day. If you have children attending the Overnight Camp, you do not need to list them here. If your child is interested in attending the Joe’s Camp overnight camp, please complete the camper registration form here.

Family Day Registration
Parent or Guardian Name*
First Last
Children's Names and Ages*
Email*
Home Phone*
Cell Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
What is your family's connection to ALS?*
How have your children reacted to the ALS diagnosis? Please specify for each child attending.*
What are you and your children hoping to gain from your experience at Joe’s Camp Family Day? Please specify for parents and each child attending.*
Do your children prefer large or small groups in social settings? Please specify for each child attending.*
Are your children comfortable making new friends? Please specify for each child attending.*
Please list any food or medication allergies you or your children have:*
Are there any special accommodations you or your children will need at camp? If so, please explain.*
Emergency Contact #1 - Name*
First Last
Emergency Contact #1 - Email*
Emergency Contact #1 - Phone*
Emergency Contact #1 - Relationship to Family*
Emergency Contact #1 - Do you authorize this person to transport your children to and from camp?*
Emergency Contact #2 - Name*
First Last
Emergency Contact #2 - Email*
Emergency Contact #2 - Phone*
Emergency Contact #2 - Relationship to Family*
Emergency Contact #2 - Do you authorize this person to transport your children to and from camp?*
Are there any individuals you do NOT authorize to transport your children to and from camp?*
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Our Mission

The Joe Martin ALS Foundation's mission is to empower families as they face the challenge of living actively with ALS by providing home care and other services at no cost.

We Believe

We believe a strong support net can help people living with ALS (PALS) and their families obtain the best caregiving techniques, equipment, and bolster their will to fight this disease.

Contact Us

704-332-1929

help@joemartinalsfoundation.org

100 North Tryon St., STE 3420
Charlotte, NC 28202

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Joe's Camp: Family Day Registration

Date: August 9-11, 2019

Location: Camp Canaan, Rock Hill, SC

Family Day Registration

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