Camper Application

Please read all the information on the camper application as it has changed. Please be aware that incomplete information will hinder the processing of your application. We appreciate your timely response to obtaining any missing information. 

Acceptances will not be mailed out until after May 1st. If your child is put on a waiting list, we will contact you when we have a cancellation. 

To view and print a copy of a camper application you will need Adobe Reader. You can download it from Adobe's web site by clicking here.

To print a camper application, please select your child's primary diagnosis:

          CANCER (243 KB - 14 pages)

          BLEEDING DISORDER (308 KB - 14 pages)

          SICKLE CELL (248 KB - 14 pages)

          GENERAL APPLICATIONS (This is the one used for all other diagnoses.)
                                                             (316 KB - 14 pages) 

If you have questions regarding your child's eligibility, please contact Patricia Carlton, Director of Nursing, at patricia.carlton@holeinthewallgang.org or Dr. Sharon Space, Medical Director, at sharon.space@holeinthewallgang.org to determine eligibility.

If you need additional forms, please select from the list below:

          CANCER MEDICAL FORM (44 KB - 2 pages)

          BLEEDING DISORDER MEDICAL FORM (47 KB - 2 pages)

          SICKLE CELL MEDICAL FORM (47 KB - 2 pages)

          CATHETER FORM (38 KB - 1 page)

          INFUSION PUMP FORM (32 KB - 1 page)

          GENERAL MEDICAL FORM (for all other diagnoses)
                                                        (46 KB - 3 pages)

          PART II QUESTIONNAIRE FORM  (23 KB - 2 pages)

If you have additional questions regarding your child's application, please contact the Camp office at 860.429.3444 or e-mail  ashford@holeinthewallgang.org.