Housing Request and Child Care Info Form

Southeast Chapter Camp 2017

To help facilitate families and child care providers at Chapter Camp, please complete the following before April 24th. I know this will seem tedious and maybe even a little redundant but it will really help us to have this information all in one place. Thanks for your understanding! Questions? amberly.ferebee@intervarsity.org

Staff

First Name

Last Name

Email Address

Phone

(###)

###

####

Do you have any specific needs or requests regarding housing in Lookout?

Will you bring a pack-n-play with you?

Who is attending with you?

Spouse

Child Care Provider

Children

Staff Spouse

First Name

Last Name

Staff Spouse will arrive on:

YYYY

Staff Spouse will leave on:

YYYY

Child Care Provider

First Name

Last Name

What is the Child Care Provider's relationship to you (mom, friend, etc)?

Child Care Provider will arrive on:

YYYY

Child Care Provider will leave on:

YYYY

Child 1

First Name

Last Name

Child 1 Age

Child 1 will arrive on:

YYYY

Child 1 will leave on:

YYYY

Does Child 1 have allergies or medical history which the camp nurse should be aware of?

Child 2

First Name

Last Name

Child 2 Age

Child 2 will arrive on:

YYYY

Child 2 will leave on:

YYYY

Does Child 2 have allergies or medical history which the camp nurse should be aware of?

Child 3

First Name

Last Name

Child 3 Age

Child 3 will arrive on:

YYYY

Child 3 will leave on:

YYYY

Does Child 3 have allergies or medical history which the camp nurse should be aware of?

Is there anything else camp organizers should be aware of regarding your family and/or child care plans?