Harvest Kids Across America Campers Two pages (Please complete all pages) This form is designed to help your camper have the most productive and fun session possible! The more the staff knows about your camper in advance, the better camp experience he/she will have. Please give us as much information as possible.  Return no later than October 12, 2008 (for all sessions). This form is shared with your child's camp counselor, unless you indicate otherwise. Camper's Name ______________________________________________________ Parent’s Name   _____________________________________________________ Home address: _____________________________________________________________________ Preferred contact number: ____________________________________________ Please provide an email address for future correspondence: __________________________________ Spiritual Background Has your child trusted Christ as His/Her Savior? ________ Have you trusted Christ as your Savior?  _______ What church do you attend regularly? ______________________________________________ Or, are you looking for a church home? ____________________________________________ Prospective Term Attending June 1 - 8, 2009 (KAA will confirm enrolled date and status) Current Grade _______ School___________________________________________________ Birth Date_____________    Age as of June 1, 2009 ___________ Please circle one: KAA1 9-11                KAA2 12-13                KAA3 14-15                KAA4 16-18          HG 15 - 18 Male_____    Female_____ Camper anticipations   ______________________________________________________________________________ Camper concern or hesitancy about Camp 2009: _______________________________________________________________________________ Camper goals for KAA ________________________________________________________________________________ Parents’ camp goals: ________________________________________________________________________________ Family members who have attended KAA: _______________________________________________________________________________ Anything office/counselor should know to make camp adjustment easier for your son/daughter? _______________________________________________________________________________ PAST YEAR Successes & accomplishments:   ______________________________________________________________________________ Disappointments, stress or traumas: ______________________________________________________________________________ PERSONAL: Hobbies: _______________________________________________________________________ Pets (names & types) _____________________________________________________________ Personality Traits: ______________________________________________________________________________ Brothers/sisters attending camp this summer ______________________________________________________________________________ Other brothers/sisters (names/ages) ______________________________________________________________________________ Regular medications: ______________________________________________________________________________ Taking at Camp? _____      *Pregnancy: ______ Enuresis: _____ Heart Disease or Problems: _____ Convulsions or Seizures: _____    Active Blood Disorder: _____   Asthma: _____ Sleepwalker: _____ Diabetic: _____ *Sickle Cell Anemia Disease: _____ last tetanus shot?  (year): ________ Primary Physician: ________________ *If yes, ineligible to attend camp ANY other special notes for counselor: include dates of illness/injury and required treatment ______________________________________________________________________________ CABIN PLACEMENT: Campers at KAA are placed in cabins according to their exact date of birth. Signed: __________________________________________________________ Date: ___________________ All checks made payable to Harvest Community Church Please note:  Your non-refundable $25.00 deposit (per camper/kaleo) is due no later than October 12th, 2008 to maintain your reserved slot.    Sabrina Young