Request for Camper Application

Please send me the information needed to send my child to Camp Sunshine Dreams held at Camp Keola, Huntington Lake, From August 8 - 15, 2005

Camp Sunshine Dreams is offered free of charge to all cancer patients and their brothers and sisters, age 8 - 15 years.


Parent/Guardian Name		  
Email (required)

 


Street Address
 

City
State
Zip
 
Phones:   Day
    Evening


Patient's Name


Date of Birth		 Male  Female

Diagnosis

Siblings Attending:
Name: DOB: Male
Female
Name: DOB: Male
Female
Name: DOB: Male
Female
Name: DOB: Male
Female