Camper Application 2021

  • Welcome to the online application for Camp Bruce McCoy 2021. All of your information will be stored securely. You can click 'Save and Continue' at the BOTTOM OF THIS PAGE at any time and resume the application at your convenience for up to 30 days. IMPORTANT: Type in your email address after you hit Save and Continue in order to receive the link to continue editing your application. IMPORTANT: Do NOT hit the back button on your browser while you are completing the application and do not hit refresh - you will lose your information. Once you are done with the application hit the Submit button. If a question does not apply to you, enter NA.
  • Very Important: After you click on Save and Continue, you may need to wait a few minutes for your changes to stick. Do not panic if you save your work and go back to review your changes - wait 5 minutes then check your edits using the link you received via email.
  • Camp this year will consist of 4 one-day camps across the state. Campers may only choose ONE day. Each day will run from 9:00am-5:00pm. Everyone who applies for camp will be contacted by Camp Management Staff to gather additional information, whether you are a returning or first-time camper.
  • Additional Dates Desired IF Available
  • Personal Information

  • Name * Required
  • Address * Required
  • Email * Required
  • Date Format: MM slash DD slash YYYY
  • Financial Assistance * Required
    Will you need financial assistance to cover the $150 camp fee? If yes, be sure to complete the separate financial aid form. Do NOT delay submitting your application because of financial need; your space at camp can be reserved while financial support is sought.
  • Parent/Guardian/Case Manager Information

  • Parent/Guardian Name
    This person will be contacted with any questions, concerns or communication relating to the camper.
  • Parent/Guardian address IF DIFFERENT than Campers
  • If there is no family contact, please provide contact info for us to use in case of emergency.
  • Address
  • Case Manager's Name if Applicable
  • Medical Information

  • If the applicant has attended camp before, has their overall level of function changed since last attending camp? If yes, please explain. If no, enter NA.
  • Should family be notified if seizure occurs or non-emergency medical treatment is required (for example, a sprained ankle or minor injury)?
  • Has the applicant been immunized for Tetanus? * Required
  • Date Format: MM slash DD slash YYYY
  • Does the applicant have an Advanced Directive? * Required
  • Does the applicant have a DNR status? * Required
  • Does the applicant have skin breakdown problems? If yes, please provide details.
  • Has the applicant visited a hospital or physician for anything other than therapy or routine medical appointments in the last 12 months? If yes, what?
  • Has the applicant had seizures? If yes, when was the last one? Indicate frequency and type of seizures; also indicate any "auras" or pre-seizure behaviors that have occurred and applicant's behavior after the seizure has ended.
  • Any known allergies? (E.g. medication, food, environmental) State allergy, nature of reaction and treatment.
  • List any non-prescription medication used by the applicant.
  • Primary Care Physician Information * Required
  • Primary Care Physician Address * Required
  • Date Format: MM slash DD slash YYYY
  • List other physicians to be contacted if a medical condition arises during camp including their Name, Specialty, and Telephone Number.
  • Insurer and Policy Number:
  • You can also use the Upload Center on the main camp page.
  • Other Forms

    A Medical Letter of Clearance and Current Medications must be signed by the applicant's primary care physician and a Release of Medical Information Form must be signed by the camper or guardian. All of these forms are available on the main camp page. Remember that your application is NOT considered complete until all of the additional forms are completed and signed.