Camper Application 2019

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We are excited about another great summer at Camp Braveheart! Junior and Teen campers will share the same week Sunday, May 26 to Friday, May 31, 2019. Camp Braveheart is for children and teens ages 7 to 17.

Camp will again be held at Camp Twin Lakes in Rutledge, Georgia. As always, Camp Braveheart will have clinical staff available 24 hours a day. Our volunteers will consist of community volunteers, nurses and other staff from Children's Healthcare of Atlanta who are committed to making Camp Braveheart a special week for your child.

Please complete this application for your child to attend camp. Camper spaces are limited and awarded on a first come, first serve basis pending approval of the camp medical team.

Our medical team will meet periodically to review completed camper applications in the order they are received. Incomplete or partial applications will not be reviewed or approved until all forms are received. The medical team will review applications for medical eligibility, any safety concerns, and our ability to manage your child's medical care in a camp setting. If our medical team has any concerns about your child's application, we will contact you to discuss.

Once the review process is complete, we will inform you by email of your child's acceptance into camp. Confirmation packets with details and more information (theme for the week, driving directions, bus info, list of things to pack, medication/packing instructions, etc.) will be emailed to campers approximately one month before camp.

Registration deadline is March 25, 2019 but we suggest you apply early as camper spaces fill quickly.

Important Tips for Completing this Application

This application should take approximately 15 to 25 minutes to complete.

If you need to save your work and return later, you will have the option to do so after completing the first form. If at any point, you choose to Save & Return Later, you will need to take down the Return Code to enter when you come back to the application. Please be sure to save this code somewhere safe so you can reference it when returning to the application. Note: each page of the application has an unique return code so you'll need to save the code for each page you are trying to return to.

DO NOT submit this application more than once! Doing so will create multiple entries in our system. If you are experiencing issues with the application or having trouble returning to your saved work, please contact us at 404-785-6735 or 404-785-1822 or email campbraveheart@choa.org.

Before beginning the application, it may be helpful to have the following items and information available.

• Emergency contact info (other than parent), including name and phone number(s)
• Your Child's Primary Care Physician name and phone number
• Your Child's Cardiologists name and phone number
• A list of your child's medications, including: medication name, dosage, day(s), times, and frequency given
• Camper and Parent e-signature is required in areas indicated

The following documents must be submitted as part of the camper application. You will have opportunity to upload the documents in this online application. Hint: You can use your smart phone to take a photo of the documents and upload.
If you are unable to upload the documents, you can fax to 404-785-6747 or email to campbraveheart@choa.org.

• A copy of your child's medical Insurance Card (front and back)
• A copy of your child's current Immunization Certificate

Your privacy is important to us. All information submitted through this application is stored in REDCap, a secure, HIPPA compliant web application used to manage our camp database.

Today's Date

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M-D-Y

Camp Start Date

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M-D-Y

My child is applying for:

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Camper First Name

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Camper Last Name

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Name Camper Goes By

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Street Address

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City

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State

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Zip Code

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County

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Gender

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Date of Birth

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M-D-Y

Age at time of camp (years)

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Current Grade in School

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Race

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T-Shirt Size

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Primary Phone Number

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Alternate Phone Number

Email Address

Enter email address again to confirm:

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Parent/ Guardian 1 First Name

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Parent/ Guardian 1 Last Name

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Parent/ Guardian 2 First Name

Parent/ Guardian 2 Last Name

Names of parents/guardians or caregivers who may pick camper up from camp or bus

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We will always contact the parent/guardian first if there is an emergency. Please provide us with an alternate contact in the event that we are unable to reach you.

Emergency Contact Full Name

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Relation to camper

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Emergency Contact Primary Phone Number

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Emergency Contact Alternative Phone Number

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