CAMP DIVAS X 2018APPLICATION REQUIREMENTS

CHILDName:

APPLICATION PROCESS These requirements must be met in order to accept your application.

Part 1. Determine if your child is in the 80th percentile. Calculate your child’s BMI using the CDC Table for Calculated Body Mass Index Values for Selected Heights and Weights for Ages 2 to 20 Years. (pdf) www.cdc.gov. Enter the results below.

Go to https://nccd.cdc.gov/dnpabmi/Calculator.aspx

Write Calculation Results: (BMI: ______) or (PERCENTILE: ______)

Part 2. Determine if your child would benefit from the Camp Divas X. Please circle. Child's age is between 10 – 15 ( Yes or No )

Willing to learn by being physically active in groups ( Yes or No )

Willing to learn by cooking healthy foods for lunch ( Yes or No )

Part 3. Complete Page 2. Pay the deposit of $25.00 or the full $150.00 Fee online at www.ChoicesForKids.org. A Payment button is located on the Camp Divas page.

Application and deposit must be received by Monday, June 4, 2018.

SUBMIT BY MAIL: 1275 Shiloh Road, Suite 2660, Kennesaw, GA 30144SUBMIT BY FAX: 678-401-7212SUBMIT BY EMAIL: info@ChoicesForKids.org

If you have questions please call, 678-819-3663.

Part 4. Scholarship assistance may be available. If applying, please attach an essay completed by your child (minimum of 250 words): “I would like to participate in Camp Divas X because…”

Scholarships are limited. Early submission of application and deposit is strongly encouraged. All requests are reviewed and decided by committee. Notification of scholarship award amounts will be made continuously.

Scholarship essays must be received not later than May 31, 2018.

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2018 CAMP DIVAS X APPLICATION(All fields required)

Please check the week your camper would like to attend:Monday - Friday, June 11 - 15, 2018 ($25 deposit - $150 total camp fee)

Monday - Friday, June 18 - 22, 2018 ($25 deposit - $150 total camp fee)

Child’sName:

Child’s Age:

Address: Child’s BMI:or percentile:

City: State Zip Code:

Parent’s Name:

Parent’sEmail:

Parent’sTel#:

Please provide the child’s email address and cell phone number, if available:

Medical History: (We may require additional information based upon responses)Are there any allergies that we should be aware of?:

Are there any medical conditions that we should be aware of?:

Has the child had a physical exam within the last year?:

Please provide an emergency contact if parent or guardian cannot be reached:

Name: Phone #:

AS PARENT OR GUARDIAN, I ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO THE CONDUCT OF THE ACTIVITIES AND TRANSPORTATION TO AND FROM THE ACTIVITIES. I further hereby release, absolve, indemnify and agree to hold harmless The Center Helping Obesity In Children End Successfully, Inc., the organizers, sponsors, volunteers, and administration of each of them from any claim, demand or action arising out of, or in any way related to the camp, including but not limited to, an injury to my child. In the event of injury, the staff is authorized to obtain any medical care or treatment deemed necessary. By signing, I acknowledge that I have read and agree to the waiver and release of liability.Signature of Camper’s Parent or Guardian Date