Wellfit Adventure Camp Application

Wellfit Adventure Camp (WAC) is a three week leadership, fitness and empowerment camp for middle girls to create connection through a unique, outdoor summer experience.

Step 1 of 7

Wellfit Adventure Camp Application
Who is completing this registration form?
Camper Information
Name*
First Last
Date of Birth*
Month
Day
Year
Age*
Address*
Street Address Address Line 2 City State ZIP Code
Which camp session are you registering for?*
School Information
School*
Grade*
Scholarship Need*
*you must provide financial statements to receive a scholarship

Parental/Guardian Information
Name*
First Last
Relationship*
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Secondary Parental/Guardian Information
Name
First Last
Relationship
Phone
Email
Address
Street Address Address Line 2 City State ZIP Code

Medical History
Wellfit Girls is a physically and emotionally demanding program. With that in mind, we must be made aware of any medical concerns prior to the program in order to provide a safe and supportive environment for the entire group. Please read the following questions thoroughly and answer honestly. Please note that we may discuss your answers with you and ask to speak to your doctor prior to your participation in the program.
How much do you typically exercise during a week?*
Please provide the activity, duration, and number of times per week
Do you have any physical limitations or medical conditions that would make camping, hiking or traveling challenging?*
* Please choose all that apply. Use the SHIFT button to select multiple options.
Other
Do you have any mental health, behavioral or emotional conditions that would make doing rigorous physical activity, being with a new group of people and/or being pushed outside your comfort zone challenging for you?*
* Please choose all that apply. Use the SHIFT button to select multiple options.
Other
How Would You Classify Your Anxiety?
- Mild
- Moderate
- Severe
Are you currently seeing a counselor/therapist?*
- Yes
- No
What is being addressed?
Please provide us with more detail on your mental health, behavioral or emotional conditions so that we can better understand and provide a safe and supportive environment for you and the group.*
List ALL medications that you are currently taking:*

All Registration Information is Confidential

Wellfit Adventure Camp Application

Step 1 of 7

Wellfit Adventure Camp Application

Camper Information

School Information

Parental/Guardian Information

Secondary Parental/Guardian Information

Characteristics

Medical History

Tell Us About You

Participant Commitment

Parent/Guardian Information