August 3-8, 2014


Request for Application
Space is limited and campers will be considered in the order their applications are received. Counselor-In-Training campers will be screened based on their application, essay and telephone interview.
* required information
Camp Dakota Request for Application 
Camper Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Birth Date:*(mm/dd/yyyy)
Gender:* Female   Male  
Additional Information
I would like more information about transportation:* Yes
No
Parentís/Guardianís name with custody:*
Guardian:* Mother
Father
Joint
Other
Home Phone:*
Work Phone:
Email:*
Type of Arthritis:*
Camperís Rheumatologist:*
Rheumatologist Phone:*
Date last seen by Rheumatologist:*(mm/dd/yyyy)
I am interested in the Counselor-In-Training Program. MUST BE 15-16 years old.: Yes
Do you need scholarship information?: Yes (All information is strictly confidential)
No
        

Before submitting any personal information, please read our Privacy Policy.