Application Form for the Anne Shore Sleep-Away Camp Program

CHILDREN

1.) Choose Your Preferred Camp Providers

Browse the Anne Shore 2021 Participating Camp Providers List.
—Note: All information therein is subject to change.
Find four (4) camp provider/session combinations that work for you and your child(ren).
In order of preference, make your camp provider/session selections below.

2.) Enter Your Child(ren)’s Name(s)

Enter the name(s) of your child(ren) in the order of placement preference.

Your "Priority #1" child should be who you are most committed to sending to camp.
Depending upon the availability of funds, you may not receive a camp placement for your "Priority #2," "Priority #3" and "Priority #4" children.

Important Note: The session dates listed within the Anne Shore 2021 Participating Camp Providers List are the ONLY dates available through the ASC Program.

Number of Children*

If space and budget permit, would you like your children to attend the same camp at the same time?

Yes

By Initialing this Box, You Understand that:*

Your camp provider options have now been limited to the ASC Program’s larger camp providers and you only need to select three (3) camp provider/session combinations. Only these larger camps have unlimited space and, if distribution allows, can accommodate ALL of your children being placed together.

First-Priority Child*

First Last

Child's Current Grade Level*

Enter a number between 2 and 11 for your child's school grade.

Please enter a number from 2 to 11.

Do you feel that your child requires or would benefit from a camp provider with special needs programming?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding your child’s possible medical and/or other special needs that may affect his or her camp experience.

Are there any special circumstances (i.e., dietary, medical, religious and/or geographic) that may affect your child’s ability to attend one of the camps on the Anne Shore 2021 Participating Camp Providers List?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding you and/or your child’s possible dietary, medical, religious, geographic and/or other special needs that may affect their camp experience.

Browse available camps.

First Priority Camp Selection*

Second Priority Camp Selection*

Please choose a second camp provider/session combination that is different from your First Priority selection.

Third Priority Camp Selection*

Please choose a third camp provider/session combination that is different from your First and Second Priority selections.

Fourth Priority Camp Selection*

Please choose a fourth camp provider/session combination that is different from your First, Second and Third Priority selections.

This abbreviated listing of camp providers/sessions is comprised of the ASC Program’s larger camp providers. Your Fourth Priority camp provider/session selection must be made from one of these larger camps.

Same Camp, Same Time - First Priority Camp Selection*

Same Camp, Same Time - Second Priority Camp Selection*

Please choose a second camp provider/session combination that is different from your First Priority selection.

Same Camp, Same Time - Third Priority Camp Selection*

Please choose a third camp provider/session combination that is different from your First and Second Priority selections.

Second Priority Child*

First Last

Child's Current Grade Level*

Please enter a number from 2 to 11.

Enter a number between 2 and 11 for your child's school grade.

Do you feel that your child requires or would benefit from a camp provider with special needs programming?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding your child’s possible medical and/or other special needs that may affect his or her camp experience.

Are there any special circumstances (i.e., dietary, medical, religious and/or geographic) that may affect your child’s ability to attend one of the camps on the Anne Shore 2021 Participating Camp Providers List?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding you and/or your child’s possible dietary, medical, religious, geographic and/or other special needs that may affect their camp experience.

Browse available camps.

First Priority Camp Selection*

Second Priority Camp Selection*

Please choose a second camp provider/session combination that is different from your First Priority selection.

Third Priority Camp Selection*

Please choose a third camp provider/session combination that is different from your First and Second Priority selections.

Fourth Priority Camp Selection*

Please choose a fourth camp provider/session combination that is different from your First, Second and Third Priority selections.

This abbreviated listing of camp providers/sessions is comprised of the ASC Program’s larger camp providers. Your Fourth Priority camp provider/session selection must be made from one of these larger camps.

Third Priority Child*

First Last

Child's Current Grade Level*

Please enter a number from 2 to 11.

Enter a number between 2 and 11 for your child's school grade.

Do you feel that your child requires or would benefit from a camp provider with special needs programming?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding your child’s possible medical and/or other special needs that may affect his or her camp experience.

Are there any special circumstances (i.e., dietary, medical, religious and/or geographic) that may affect your child’s ability to attend one of the camps on the Anne Shore 2021 Participating Camp Providers List?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding you and/or your child’s possible dietary, medical, religious, geographic and/or other special needs that may affect their camp experience.

Browse available camps.

First Priority Camp Selection*

Second Priority Camp Selection*

Please choose a second camp provider/session combination that is different from your First Priority selection

Third Priority Camp Selection*

Please choose a third camp provider/session combination that is different from your First and Second Priority selections.

Fourth Priority Camp Selection*

Please choose a fourth camp provider/session combination that is different from your First, Second and Third Priority selections.

This abbreviated listing of camp providers/sessions is comprised of the ASC Program’s larger camp providers. Your Fourth Priority camp provider/session selection must be made from one of these larger camps.

Fourth Priority Child*

First Last

Child's Current Grade Level*

Please enter a number from 2 to 11.

Enter a number between 2 and 11 for your child's school grade.

Do you feel that your child requires or would benefit from a camp provider with special needs programming?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding your child’s possible medical and/or other special needs that may affect his or her camp experience.

Are there any special circumstances (i.e., dietary, medical, religious and/or geographic) that may affect your child’s ability to attend one of the camps on the Anne Shore 2021 Participating Camp Providers List?*

Yes
No

In an effort to best accommodate your needs, you will be contacted for additional information regarding you and/or your child’s possible dietary, medical, religious, geographic and/or other special needs that may affect their camp experience.

Browse available camps.

First Priority Camp Selection*

Second Priority Camp Selection*

Please choose a second camp provider/session combination that is different from your First Priority selection.

Third Priority Camp Selection*

Please choose a third camp provider/session combination that is different from your First and Second Priority selections.

Fourth Priority Camp Selection*

Please choose a fourth camp provider/session combination that is different from your First, Second and Third Priority selections.

This abbreviated listing of camp providers/sessions is comprised of the ASC Program’s larger camp providers. Your Fourth Priority camp provider/session selection must be made from one of these larger camps.

Anne Shore Sleep-Away Camp Program

Step 1 of 4 - Overview of Eligibility and Benefit Distribution

INSTRUCTIONS

First – Choose Your Camps and Prioritize Your Selections

Eligibility and Consideration for Benefits

Distribution and Camp Placement

Administrative Fee

IMPORTANT

MEMBER

CHILDREN

1.) Choose Your Preferred Camp Providers

2.) Enter Your Child(ren)’s Name(s)

Media Release

Application and Participation

Taxable Benefit