Real Angel Tree Registration - Camp Occohannock on the Bay

Please Read Before Filling Out Form

This form is specific to campers who have a loved on who is incarcerated (in prison). It is a special program. If your camper needs scholarship but doesn't fit into this category they must click on the scholarship button form on the summer camp pages.

Camper Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Gender

Date of Birth *

Grade *What grade are they finishing in 2023-20240 / 2

T-Shirt Size

Is this the first time away from home?

Is this the first time at Camp OOTB?

What type of swimmer is your Camper?

What week of camp are you applying for?Descriptions: https://www.ootbay.org/wp-content/uploads/2021/11/Summer-Camp-Brochure.pdf

Is there anything we need to know to help your camper have a fun, safe and enjoyable week?

I would like to use the Virginia Beach Pick Up Option. Transportation from Virginia Beach United Methodist Church to CampLocation for pick up: 212 19th St, Virginia Beach, VA 23451

Name of Incarcerated Family Member *

Last Known Facility (of Incarcerated Family Member) *

Relationship to Camper *

Health Form

A PARENT OR GUARDIAN MUST COMPLETE THIS FORM. THE DIRECTORS, HEALTH COORDINATOR AND CAMP COUNSELORS WILL HOLD INFORMATION FROM THIS FORM CONFIDENTIAL. THE INTENT OF THIS FORM IS TO PROVIDE THE CAMP DIRECTOR AND HEALTH COORDINATOR THE INFORMATION NEEDED TO PROVIDE APPROPRIATE EMERGENCY CARE. KEEP A COPY OF THIS FORM FOR YOUR RECORDS. ATTACH ADDITIONAL PAGES OR DESCRIPTIONS AS NEEDED. PROVIDE CHANGES TO THIS FORM TO THE HEALTH COORDINATOR AT CHECK- IN ON THE FIRST DAY OF CAMP.

List Any Known Allergies and Reactions *

Health Insurance Company

Group Number / Policy Number

Name of Physician & Phone Number

Does your child have any Dietary Restrictions?

Diet & NutritionEats a regular dietVegan (no meats, seafood, eggs, or dairy)Vegetarian (no meats)Gluten-Free (Celiac)Gluten-Free (Allergy or Preference)Dairy FreeDoes your camper....

Medical History

Do you attest that all immunizations required for school are up to date for this camper?YesNo

Will you be providing any over the counter medications or prescriptions medications for your camper?

Does your child have any special needs or issues including physical, emotional, health or behavior that the Camp Director should know?

Please describe any special needs or issues including physical, emotional, health or behavior that the Camp director and Staff should know about in advanced:

Does your camper have a cabin buddy registered they would like to stay with?

If there are other Medical Conditions please describe below:

Describe any other past or current injury, illness, disease, treatment, surgery, or affliction the camp should know about in case of emergency.

Church Membership

Church Name

Pastor's Name

Church location or town

How did you hear about OOTB?

Emergency Contact Information

Who do we contact in case of emergency?

Emergency Contact 1

Phone

Email Address

Relation to Camper

Emergency Contact 2

Phone

Email Address

Relation to Camper

Parent/Guardian Information

Primary Parent/Guardian

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address

Home Phone

Cell Phone