Today M-D-Y
Camp Strong4Life is an overnight summer camp for kids 8 to 12 years old who have a BMI greater than the 85th percentile. Campers will learn about healthy habits while participating in typical camp activities like rock climbing, kyaking, team building and more!
Camp Week is June 9-14, 2024 at Camp Twin Lakes in Rutledge, GA.
Acceptance to camp is on a first come, first serve basis.
Camp Strong4Life is a family based approach where we not only teach kids about healthy habits but caregivers too. We believe that empowering caregivers with the tools to promote healthy living in the home, is the best way to support raising healthy, safe, resilient kids. Parents/guardians and campers are required to attend an in-person orientation on May 18 or 19, 2024 to learn about the Strong4Life healthy habits and what to expect at camp.
This application will take approximately 30 minutes to complete. The following items are needed to complete this application:
Medical form signed by a clinician Immunization records Medical insurance card (if applicable ) $50 registration fee (Please note: Financial scholarships and payment plans are available for eligible campers) . Forms may be submitted at a later date if needed, but your application will not be reviewed until all documentation is submitted.
Click the link below to download a blank copy of the medical and immunization forms.
At this time, the following Covid vaccination policy has been approved for all campers, volunteers, and staff attending a Children's Healthcare of Atlanta Camp:
The primary Covid-19 vaccination series is recommended to attend any in-person, overnight camp. 1 updated Pfizer-BioNTech or Moderna bivalent vaccine is recommended Masking and testing requirements will be decided and communicated prior to each camp program. As a result of the COVID-19 pandemic, we continue to make decisions in accordance with best practices and guidelines from the Centers for Disease Control, American Camp Association, local health authorities, and medical professionals. Our highest priority is to provide a safe and healthy environment for our campers and staff.
Please select below indiciating you are aware of the COVID-19 vaccination policy for Camp Strong4Life:
* must provide value
I acknowledge the COVID-19 vaccination policy I acknowledge the COVID-19 vaccination policy
By checking below, I/my camper confirm our availability to attend the following camp events:
Orientation: In-person session to learn about Strong4Life and what to expect at camp. You may attend orientation on either Saturday, May 18 or Sunday, May 19 in Brookhaven, GA
Camper Week: June 9-14, 2024 at Camp Twin Lakes Rutledge, GA
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I will attend both the orientation and camper week
I will attend both the orientation and camper week
Parent/Guardian First Name
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Parent/Guardian Last Name
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Your relationship to the camper
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Mother Father Legal Guardian Grandparent Step-parent Other
Parent/Guardian email address
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This email will be used for all camp related communication
Parent/Guardian phone number
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List all legal parents/ guardians of child
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What is the highest level of schooling that the camper's primary guardian has completed?
* must provide value
High School Some college Associates Bachelors Masters Doctorate Professional degree
Used for grant and fundraising purposes
Are you an employee of Children's Healthcare of Atlanta?
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Yes No
How did you hear about Camp Strong4Life? Select all that apply.
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My child's doctor Strong4Life Clinic My child is a returning camper Fit Together Gwinnett Letter received via mail Web search Children's Healthcare of Atlanta website (choa.org) Strong4Life website (Strong4Life.com) Strong4Life Newsletter Facebook or Instagram I am a Children's employee Family member or friend Camp Twin Lakes Community event My child's school Other
Name of doctor and practice that referred you to camp:
Specify how you heard about Camp Strong4Life:
Are you applying for more than one child to attend Camp Strong4Life?
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Yes No
Please Note : A separate application must be filled out for each child.
Camper First Name
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Name camper wishes to be called
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Camper Last Name
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Date of birth
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M-D-Y
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Camp Strong4Life is for kids 8-12 years old. For questions, email CampStrong4Life@choa.org
Biological Sex
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Male Female
Gender Identification
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Boy Girl Non-Binary
Preferred Pronoun
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He, Him She, Her They, Them Other
Asian Black Caucasian Hispanic Multi-Racial Native American Other
Primary language(s) spoken in the home
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If other, please specify.
What grade is your child entering in the Fall of 2024?
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3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade Other
Height in feet
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3 4 5 6
Height in inches
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0 1 2 3 4 5 6 7 8 9 10 11
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Weight in pounds
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Enter numbers only
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T-shirt size
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Youth small Youth medium Youth large Youth XL Adult small Adult medium Adult large Adult XL Adult 2XL Adult 3XL Adult 4XL
Camper's shoe size
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Youth 3 Youth 4 Youth 5 Youth 6 Women's 6 Women's 7 Women's 8 Women's 9 Women's 10 Women's 11 Women's 12 Women's 13 Women's 14 Women's 15 Men's 5 Men's 6 Men's 7 Men's 8 Men's 9 Men's 10 Men's 11 Men's 12 Men's 13 Men's 14 Men's 15
(If in between sizes, please select the next size up)
Shoe Width
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Narrow Standard Wide (Women's D/ Men's 2E) Extra wide (Women's 2E+/ Men's 4E+)
Has your child attended Camp Strong4Life before?
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Yes No
Is this your child's first overnight camp experience?
* must provide value
Yes No
Does your child have an appointment scheduled at the Strong4Life clinic this year (2024)?
* must provide value
Yes No
Is your child a previous patient at the Strong4Life clinic?
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Yes No
Please list additional camper's names:
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Street address
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State
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Georgia Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
County
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Atkinson County Bacon County Baker County Baldwin County Banks County Barrow County Bartow County Ben Hill County Berrien County Bibb County Bleckley County Brantley County Brooks County Bryan County Bulloch County Burke County Butts County Calhoun County Camden County Candler County Carroll County Catoosa County Charlton County Chatham County Chattahoochee County Chattooga County Cherokee County Clarke County Clay County Clayton County Clinch County Cobb County Coffee County Colquitt County Columbia County Cook County Coweta County Crawford County Crisp County Dade County Dawson County Decatur County DeKalb County Dodge County Dooly County Dougherty County Douglas County Early County Echols County Effingham County Elbert County Emanuel County Evans County Fannin County Fayette County Floyd County Forsyth County Franklin County Fulton County Gilmer County Glascock County Glynn County Gordon County Grady County Greene County Gwinnett County Habersham County Hall County Hancock County Haralson County Harris County Hart County Heard County Henry County Houston County Irwin County Jackson County Jasper County Jeff Davis County Jefferson County Jenkins County Johnson County Jones County Lamar County Lanier County Laurens County Lee County Liberty County Lincoln County Long County Lowndes County Lumpkin County Macon County Madison County Marion County McDuffie County McIntosh County Meriwether County Miller County Mitchell County Monroe County Montgomery County Morgan County Murray County Muscogee County Newton County Oconee County Oglethorpe County Paulding County Peach County Pickens County Pierce County Pike County Polk County Pulaski County Putnam County Quitman County Rabun County Randolph County Richmond County Rockdale County Schley County Screven County Seminole County Spalding County Stephens County Stewart County Sumter County Talbot County Taliaferro County Tattnall County Taylor County Telfair County Terrell County Thomas County Tift County Toombs County Towns County Treutlen County Troup County Turner County Twiggs County Union County Upson County Walker County Walton County Ware County Warren County Washington County Wayne County Webster County Wheeler County White County Whitfield County Wilcox County Wilkes County Wilkinson County Worth County Other
Ex. Fulton County
Zip code
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Indicate the total income per year for your household
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Less than $30,000 per year Between $30,000 and $70,000 per year More than $70,000 per year Prefer not to say
Information is used for grant and fundraising purposes.
How many total people live or stay in the same home as the camper (including the camper)?
* must provide value
Information is used for grant and fundraising purposes.
Are you requesting a financial assistance scholarship to assist with the cost of camp?
* must provide value
Yes No
If yes, you will be prompted to complete a brief financial aid form following this application
Within the past 12 months we worried whether our food would run out before we had money to buy more.
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Often True
Sometimes True
Never True
Don't Know/ Refused
Often True
Sometimes True
Never True
Don't Know/ Refused
Information is used for grant, fundraising, research, and program development purposes
Within the past 12 months the food we bought didn't last and we didn't have money to buy more.
* must provide value
Often True
Sometimes True
Never True
Don't Know/ Refused
Often True
Sometimes True
Never True
Don't Know/ Refused
Information is used for grant, fundraising, research, and program planning purposes
Provide the name of your child's Primary Care Physician.
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Provide the office of your child's Primary Care Physician.
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Provide the telephone number of your child's Primary Care Physician office.
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The information collected in this section is very important to ensure your camper has the most enjoyable and safest camp experience. Answer all questions to the best of your ability.
Select any conditions your child has been diagnosed with:
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Provide details and dates about your child's ADD or ADHD diagnosis:
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Provide details and dates about your child's anxiety diagnosis:
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Provide details and dates about your child's asthma/ wheezing/ shortness of breath diagnosis:
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Provide details and dates about your child's autism diagnosis:
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Provide details and dates about your child's bleeding/clotting disorder diagnosis:
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Provide details and dates about your child's back/ joint problems diagnosis:
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Provide details and dates about your child's Cerebral Palsy diagnosis:
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Provide details and dates about your child's chest pain diagnosis:
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Provide details and dates about your child's depression diagnosis:
* must provide value
Provide details and dates about your child's developmental delay diagnosis:
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What is your child's cognitive age?
* must provide value
The approximate age that a camper may be perceived if he or she has developmental delays.
Provide details and dates about your child's diabetes diagnosis:
* must provide value
Provide details and dates about your child's eating disorder diagnosis:
* must provide value
Provide details and dates about your child's Epilepsy/ seizure disorder diagnosis:
* must provide value
Provide details and dates about your child's fainting/dizziness diagnosis:
* must provide value
Provide details and dates about your child's heart defect diagnosis:
* must provide value
Provide details and dates about your child's skin condition:
* must provide value
Provide any details about your child's sleep apnea diagnosis:
* must provide value
Provide any details about other mood/ behavioral diagnoses or concerns not listed above:
* must provide value
Provide any details about other physical diagnoses or concerns not listed above:
* must provide value
Has your child been hospitalized in the past year (this includes physical, mental, and behavioral conditions)?
* must provide value
Yes No
List dates and details of each hospitalization:
* must provide value
Has your child had surgery in the past year?
* must provide value
Yes No
Describe surgery type and dates:
* must provide value
Is your child able to use tampons during camp?
* must provide value
Yes No Child not yet menstruating
Has your child had mononucleosis ("mono") during the past 12 months?
* must provide value
Yes No
Provide approximate dates:
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Is your child under the care of a counselor, psychologist, or psychiatrist?
* must provide value
Yes No
Provide details:
* must provide value
Has your child had a significant life event that continues to affect the camper's life (e.g. recent death of a family member, divorce, trauma, etc.)?
* must provide value
Yes No
Provide details:
* must provide value
Has your child had thoughts of suicide in the past 2 years?
* must provide value
Yes No
Has your child attempted suicide in the past 2 years?
* must provide value
Yes No
Does your child have a safety plan in the event of having thoughts of suicide?
* must provide value
Yes No
Please explain in detail their safety plan or attach a document of their safety plan:
* must provide value
Upload your child's safety plan here:
Any additional comments or things we should know regarding your camper's physical health or mental health history ?
Is your child allergic to any medications?
* must provide value
Yes No
List the medication(s) your child is allergic to:
* must provide value
What is your child's reaction to each medication?
* must provide value
Ex. hives, swelling
Does your child have any environmental and/or animal allergies?
* must provide value
Yes No
List your child's environmental and/or animal allergies and reaction to each allergen.
* must provide value
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Does your child have any food allergies?
* must provide value
Describe your child's peanut allergy:
* must provide value
Cannot eat peanuts Cannot be in the same room as peanuts Other
If other, please explain:
What is your child's reaction to peanuts? (e.g. Hives, Anaphylaxis, etc.)
Ex. hives, swelling
Please list the types of tree nuts is your child allergic to:
Please describe your child's tree nut allergy:
Cannot eat tree nuts Cannot be in the same room as tree nuts Other
If other, please explain:
What is your child's reaction to treenuts? (e.g. Hives, Anaphalaxis, etc.)
Ex. hives, swelling
What is your child's reaction to eggs? (e.g. Hives, Anaphalaxis, etc.)
Ex. hives, swelling
What is your child's reaction to shellfish? (e.g. Hives, Anaphalaxis, etc.)
Ex. hives, swelling
Describe your child's gluten allergy:
* must provide value
Cannot eat foods containing gluten Cannot be in the same room as food containing gluten Other
If other, please explain:
* must provide value
List other food allergies and describe the reaction your child has to those foods:
Does your child use/carry an Epi (epinephrine) pen for any of their allergies?
* must provide value
Yes No
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Select any dietary restrictions your child has:
* must provide value
Describe any other food restrictions your child has:
* must provide value
Sleep Habits (Select all the apply)
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Other sleep issues, please describe:
Describe special bedtime routines or sleep habits.
Include any special needs, comfort items your child will bring, or bedtime rituals your child will need while away at camp
* must provide value
Does your child have a history of bedwetting in the past year? During camp week, the Camp Strong4Life team washes all sheets that were soiled over night or during rest hour.
* must provide value
Yes No
Provide details:
* must provide value
Does your child commonly need help from an adult with toileting or hygiene in their daily routine?
* must provide value
Yes No
Describe the best way to help your child with hygiene or toileting:
* must provide value
Has your child had any behavioral concerns in the past year?We are asking this information to better support your child while they are at camp.
* must provide value
Yes No
If yes, please explain the situation.
* must provide value
Describe how your camper gets along at home, in school and with peers.
* must provide value
If your child becomes upset, what is the best way to help them cope?
* must provide value
Please select any special items that your camper will be bringing to camp (Select all that apply):
* must provide value
List any other special equipment:
Select your child's swimming ability.
* must provide value
Cannot swim
With life vest and 1:1 assistance from counselor
Can stay afloat needs constant supervision
Some swimming ability must be able to touch bottom
Swimmer shallow end only
Swimmer can go in deep end
Other
Cannot swim
With life vest and 1:1 assistance from counselor
Can stay afloat needs constant supervision
Some swimming ability must be able to touch bottom
Swimmer shallow end only
Swimmer can go in deep end
Other
Your child will be required to take a swim test the first day of camp to determine if he/she can go into the deep end of the pool. Counselors will assist in the pool and there will be lifeguards present at all times.
Describe other swimming ability:
* must provide value
What are some of your camper's favorite hobbies and things to do?
Feel free to share any information about your camper so we can help make their camp experience great!
Does your camper take any medications regularly? This includes vitamins, over the counter medicines, and prescriptions.
* must provide value
Yes No
List the names of ALL medications your child takes regularly.
(Note: detailed information on medication dosing/administration will be collected closer to camp )
* must provide value
Is there anything else we should know that will make camp a positive experience for your child?
Please click "submit" to go to the next section of the application.
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