Home - National Multiple Sclerosis Society

Skip to navigation Skip to content

2020 Champ Camp Application - Burton, TX

 

Champ Camp Weekend takes place at Camp For All in Burton, Texas from March 13-15, 2020.  This recreational and educational weekend is designed for children living with MS and their families.  Parents attend this camp with their children, and siblings are also invited to attend.

Space at camp is limited; incomplete applications or those received after the application submission deadline may be placed on a waiting list.

Please note that you may experience technical difficulties when submitting an application using Internet Explorer. If possible, we would encourage you to use an alternate browser such as Google Chrome or Firefox in order to complete a Champ Camp application.  

Please contact Lissa Giacco at lissa.giacco@nmss.org with questions.

1. Please complete the following with parent name and information.

If you have previously registered, please login here to prepopulate your information.

*

Name:

 

 

   

*

*

 

*

City/State/ZIP:

 

    

*

 

 

 

What's this?

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

*

5 to 60 characters

*

5 to 20 characters

*

 


*2.  


*3.  


*4.
Question - Required - Youth's gender:


*5.
Question - Required - Youth's date of birth:




*6.  


*7.  


*8.  


*9.

(Maximum response 255 chars, approx. 5 rows of text)

 

Parent Registration Information

*10.  


11.  


12.  


13.  


14.  


15.  


16.  


17.  


18.  


19.  


 

Sibling Registration Information

If your child's siblings will be attending Champ Camp, please list their information in the space below.  If your child does not have siblings who will be attending Champ Camp, you may skip this section.  

20.  


21.  


22.  


23.  


24.  


25.  


26.  


27.  


28.  


 

Champ Camp Important Health Information

Please provide any relevant information regarding your child with MS.  This information will be kept on file with the National MS Society. It's used to facilitate a safe and enjoyable experience for youth and staff. Confidentiality is respected.

*29.  


*30.

(Maximum response 255 chars, approx. 5 rows of text)

*31.

(Maximum response 255 chars, approx. 5 rows of text)

*32.

*33.

*34.

*35.

 

Additional Registration Information

*36.


*37.

(Maximum response 255 chars, approx. 5 rows of text)

*38.

(Maximum response 255 chars, approx. 5 rows of text)

*39.
Question - Required - If accepted, camp materials are available in both paper and electronic versions. Please let us know which way you would prefer to receive these documents.


 

Please indicate your agreement and understanding by placing your initals next to each of the remaining items:

*40.  


*41.  


*42.


 

All Champ Camp applicants must also sign and return a waiver.  Please download, print, sign and return this waiver to Lissa Giacco at 8111 N. Stadium Drive, Houston, TX 77054.  If you are unable to print the waiver and need one sent to you, please contact Lissa at lissa.giacco@nmss.org.

   Please leave this field empty