Camper Information Form
Progress: 
 

1. Which Curiosity Quest Problem Solvers Camp are you registering for? 

Curiosity Quest Problem Solvers West
Curiosity Quest Problem Solvers East
2. Camper Information

First Name:
Middle Name:
Last Name:
Age at the beginning of Camp:
Grade child will enter in September:
Prefers to be addressed as:

3. Gender Identification
Male
Female

4. T-shirt size: 

Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Xtra Large
Family Information
 

5. Camper lives with:

(please use comment box to explain any special circumstances) 

Both parents
Mother
Father
Other
  • Comment:

  • 500 characters left.
6. Name of Parent or Guardian (Primary Contact)
 

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7. Street Address, City, State, Zip  

 

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8. Home Phone 

 

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9. Cell Phone  

 

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10. Email Address 

 

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11. Occupation

 

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12. Work/Day Phone 


 

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13. Preferred contact method 
Home Phone
Work Phone
Cell Phone
Email

14. Name of Parent or Guardian (Secondary Contact) 

 

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15. Street address, City, State, Zip 

 

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16. Home Phone 

 

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17. Cell Phone 

 

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18. Email Address 

 

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19. Occupation

 

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20. Work/Day Phone 


 

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21. Preferred contact method 

Home Phone
Work Phone
Cell Phone
Email
To Be Completed by the Parent or Guardian
 
22. Have you attended the camp you are applying for before?
Yes. Use comment box to indicate which year(s) and location(s) you attended.
No
  • Comment:

  • 500 characters left.
23. Has your child been formally identified as gifted; or is your child in a gifted program at school; or is your child home schooled primarily due to special needs related to advanced abilities?  Please describe assessments given or abilities demonstrated.
 

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24. What talent(s) does your child possess?  What is/are your child's particular strength(s) and interest areas?  

 

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25. Please check the following attributes that describe your child: 

Reasons well (good thinker)
Learns rapidly
Has extensive vocabulary
Has an excellent memory
Has a long attention span (if interested)
Sensitive (feelings hurt easily)
Shows compassion
Perfectionist
Intense
Morally sensitive
Has strong curiosity
Prefers older companions or adults
Has a wide range of interests
Has a great sense of humor
Tends to question authority
Concerned with justice, fairness
Judgement mature for age
Is a keen observer
Has a vivid imagination
Is highly creative
  • Comment:

  • 500 characters left.

26. What are challenge areas for your child or less developed abilities that would benefit from extra support? 

 

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27. Why do you want your child to attend this camp? 

 

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28. Has your child attended camp before? 

Yes
No
29. If yes, what camp(s) did he/she attend?  Did your child enjoy this/these camps?  what did he/she enjoy the most?  What did he/she enjoy the least?
 

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30. Were any of the camps your child has attended overnight (residential) camps? Which ones? 

 

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31. Has your child otherwise stayed away overnight without you before?  In what situation? 

 

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32. Are any friends of your child planning on attending camp with your child?  If so, please list names: 

 

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33.  Name(s) and age(s) of sibling(s): 

 

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34. Are any siblings planning to attend Curiosity Quest Problem Solvers? If yes, which camp (West, East, Both)? 


 

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35. Does your child have any allergies?  If so, what medications does he or she take?  Does he/she us an EpiPen?  Are any allergies (e.g., peanuts) life-threatening? 


 

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36. Does your child take any other medication?  If so, please indicate medication and condition.  Please also list any other medical conditions that do not require any medication. 

 

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37. Does your child have any special dietary needs other than food allergies mentioned above?  Any food restrictions needs to be communicated to us 3 weeks prior to camp for us to be able to accommodate.

 

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38. Has your child been diagnosed with any emotional conditions (e.g. depression, anxiety)? 

 

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39.  Has your child been diagnosed with any learning or developmental disorders (e.g., ADD/ADHD Asperger's Disorder, dyslexia)? 

 

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40. Does your child have any special needs? 

 

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41. Does your child swim? If so, how well?
 

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42. Is there anything else you would like to share with us about your child? 

 

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To Be Completed by the Camper
 
43. Do you wish to attend camp? 
Yes
No
44. What do you think you will like most about camp? 
 

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45. What do you want to get out of your camping experience? 

 

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46. What activities do you want to participate in the most? 

 

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47. When are you the happiest? 

 

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