A member of the Camp Bangarang team will reach out to you to learn more about your camper, and how we can best serve you! Which camp will you be attending?Iowa camp Sep 6th - 8thIllinois camp Oct 18th - 20thParent / Guardian Name*Camper's Name*Camper's Age*Camper's Grade*Email* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about us?*MessageParent / Guardian 1PG1 NamePG1 Any Special Dietary needs?PG1 Any physical or adaptive needs?PG1 Any Allergies we should be aware of?PG1 Any other medical or personal needs we should know?PG1 What is your Favorite Movie?PG1 Favorite Hot Beverage?PG1 Favorite Food?PG1 Favorite Song?PG1 Favorite Candy?Parent / Guardian 2PG2 NamePG2 Any Special Dietary needs?PG2 Any physical or adaptive needs?PG2 Any Allergies we should be aware of?PG2 Any other medical or personal needs we should know?PG2 What is your Favorite Movie?PG2 Favorite Hot Beverage?PG2 Favorite Food?PG2 Favorite Song?PG2 Favorite Candy?Other adult friend/family coming alongPG3 NamePG3 Any Special Dietary needs?PG3 Any physical or adaptive needs?PG3 Any Allergies we should be aware of?PG3 Any other medical or personal needs we should know?PG3 What is your Favorite Movie?PG3 Favorite Hot Beverage?PG3 Favorite Food?PG3 Favorite Song?PG3 Favorite Candy?Qualifying CamperThis would be your child with a serious medical diagnosisDiagnosis*Any Special Dietary needs?Any physical or adaptive needsAny Allergies we should be aware of?Any other medical or personal needs we should know?What is your Favorite Food?Favorite Sport/Game?Favorite thing to do at Home?Favorite Song?Favorite Candy?Sibling 1Sibling 1 NameSibling 1 Birthday Sibling 1 AgeSibling 1 GradeSibling 1 Any Special Dietary needs?Sibling 1 Any physical or adaptive needs?Sibling 1 Any Allergies we should be aware of?Sibling 1 Any other medical or personal needs we should know?Sibling 1 What is your Favorite Food?Sibling 1 Favorite Sport/Game?Sibling 1 Favorite thing to do at Home?Sibling 1 Favorite Song?Sibling 1 Favorite Candy?Sibling 2Sibling 2 NameSibling 2 Birthday Sibling 2 AgeSibling 2 GradeSibling 2 Any Special Dietary needs?Sibling 2 Any Allergies we should be aware of?Sibling 2 Any physical or adaptive needs?Sibling 2 Any other medical or personal needs we should know?Sibling 2 What is your Favorite Food?Sibling 2 Favorite Sport/Game?Sibling 2 Favorite thing to do at Home?Sibling 2 Favorite Song?Sibling 2 Favorite Candy?Sibling 3Sibling 3 NameSibling 3 Birthday Sibling 3 AgeSibling 3 GradeSibling 3 Any Special Dietary needs?Sibling 3 Any Allergies we should be aware of?Sibling 3 Any physical or adaptive needs?Sibling 3 Any other medical or personal needs we should know?Sibling 3 What is your Favorite Food?Sibling 3 Favorite Sport/Game?Sibling 3 Favorite thing to do at Home?Sibling 3 Favorite Song?Sibling 3 Favorite Candy?Accommodation NeedsThe typical cabin will have twin sized bunk beds. If families own twin sized bedding, we ask that they bring it. If you do not have that size bedding, camp will make sure you are covered (literally)!Do you need wheelchair accessible accommodations?*YesNoDo you need camp to provide twin sized bedding?*YesNoNumber of beds you need supplied by Camp*There is a refrigerator in the nurses station, but we can also arrange for you to have a small fridge in your cabin if medically necessary? (Note: We will have an RN on site for any assistance you may need 24 hours a day)*NecessaryNot necessaryDo you need a nightlight?*YesNoOther accommodation info you think we should know?Your cabin will be private for your family (families will not share sleeping space) However if there is a family you are very close with and wish to be accommodated with or near them please let us know! T-shirts!!!Please list the number of each size needed for your family (for example if you need two child mediums just put the number “2” next to that size) These are in what we consider unisex t-shirt sizes We will bring some extras in each size in case yours doesn’t fit so no worries! Adult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult 3XLYouth LargeYouth MediumYouth Small5T4T3TPHOTO RELEASEYou guys are the face of Camp Bangarang! Photos can be a huge help for Camp Bangarang! Photos and videos help us spread the word to other families, donors, volunteers and supporters so that we can serve more and more kids. We also want to respect you and your family’s privacy! We will always check before using a photo. These are primarily for other families interested in camp to see on the photo page of campbangarang.org, in our Spring and Fall newsletters, and things like that.Permission to use photograph/video I grant to Camp Bangarang, its representatives and employees the right to take photographs/video of me and my family while participating in Family Weekend Camp. I agree that Camp Bangarang may use such photographs/videos of me with or without my name and for any lawful purpose including print or electronically. This may include social media, publicity marketing, advertising, and web content. Photo release*I have read, understand, and agree the above.I would prefer Camp Bangarang NOT use any photos of me or my family in camp promotion - thanks. This iframe contains the logic required to handle Ajax powered Gravity Forms.