Joe's Camp: Camper Registration

Date: August 9-11, 2019

Location: Camp Canaan, Rock Hill, SC

Check In: 5:00 PM, Friday
Check Out: 3:00 PM, Sunday

Please complete the following information for each child in your interested in attending the Joe’s Camp Overnight Camp. If your family will attend the Joe’s Camp Family Day, please complete online the registration form, here.

Overnight Camp Registration
How many children would you like to register?*
Child #1 - Name*
First Last
Child #1 - Age*
Please enter a number from 0 to 99.
Child #1 - Date of Birth*
Date Format: MM slash DD slash YYYY
Child #1 - Grade in School*
Child #2 - Name*
First Last
Child #2 - Age*
Please enter a number from 0 to 99.
Child #2 - Date of Birth*
Date Format: MM slash DD slash YYYY
Child #2 - Grade in School*
Child #3 - Name*
First Last
Child #3 - Age*
Please enter a number from 0 to 99.
Child #3 - Date of Birth*
Date Format: MM slash DD slash YYYY
Child #3 - Grade in School*
Child #4 - Name*
First Last
Child #4 - Age*
Please enter a number from 0 to 99.
Child #4 - Date of Birth*
Date Format: MM slash DD slash YYYY
Child #4 - Grade in School*
Parent or Guardian Information
Parent or Guardian Name*
First Last
Email*
Home Phone*
Cell Phone*
Billing Contact Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Additional Camper Information
Please complete each question in this section with answers for each child attending camp.
What is your child's connection to ALS?*
How has your child reacted to the ALS diagnosis?*
What are you hoping your child will gain from their experience at Joe’s Camp?*
Has your child attended a sleep away camp before? If no, is your child comfortable spending the night away from home?*
Does your child prefer large or small groups in social settings? Please explain.*
Is your child comfortable making new friends?*
Please list any food or medication allergies your child has:*
Will your child be taking medication while at camp? If so, please list the medicine and dosage information. (Please note: you will need to provide the medication plus 2 extra days for our medical staff to administer while at camp.)*
Are there any special accommodations your child will need at camp? If so, please explain.*
Emergency Contact & Transportation
Emergency Contact #1 - Name*
First Last
Emergency Contact #1 - Email*
Emergency Contact #1 - Phone*
Emergency Contact #1 - Relationship to Camper*
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 Camper*
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

Hello World

Joe's Camp: Camper Registration

Date: August 9-11, 2019

Location: Camp Canaan, Rock Hill, SC

Overnight Camp Registration

Parent or Guardian Information

Additional Camper Information

Emergency Contact & Transportation

Our Mission

We Believe

Contact Us

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