Camp Cares 2023 - VetCares

PROGRAM REQUIREMENTS

- Background check will be required to participate in the event. - No alcohol, drugs or weapons of any kind will be allowed while participating in the event. - Bag checks will be performed upon checking into cabins. - A list of required medications to be provided to us prior to arrival.

Signature (I understand and agree to the above Program Requirements)

Full Name of applicatnt

APPLICANT INFORMATION

Cell Phone Number(Required)

Alternative Number

Date of Birth(Required)

Email(Required)

MILITARY DETAILS

Please list branch of service/affiliation

Military status

Job Title

Pay Grade

Time of Service (Start Date)

Command

VA Disability Rating

Personal Military Awards

Dates of deployment(s)? If/when will you deploy? Location of deployment(s)?

CC PROGRAM INFORMATION

How did you hear about the CC Grant?

Who referred you to the CC Grant?

Have you been approved to attend an alternative therapy with any other organization? If so, what is the name of the organization and what dates will you be attending the program?

Have you attended, currently attending, or scheduled to attend other alternative programs? If so, please list them.

Have you obtained other grants/resources in the past 2 years from other organizations? If so, please list each one.

Please list the alcohol or drug rehabilitation program.

Do you have any limitations to prevent certain activities?

Any medical assistance or special equipment needed to assist you while at the event?

Are you allergic to any medications, food, or other substances? If Yes, please list them:

Should you have an allergic event, what is your procedure? (If this doesn’t apply to you, please enter N/A):

Are you currently taking any medications and/or have specific needs that we should be made aware of (i.e., seizures, blackouts, etc.)? (If this doesn’t apply to you, please enter N/A)

Please list below any concerns you may have while participating in the event

In Case of Emergency Contact Info

Name

Phone/Text

Relationship

Name

Phone/Text

Relationship

GEAR SIZES/INFORMATION

Shoulders (inches)

Waist (inches)

Chest (inches)

Hips (inches)

Shoe Size

Weight

Height

REFERENCES - List 2 References

Phone (Reference 1)

Phone (Reference 2)

DOCUMENTATION REQUIREMENTS

Proof of Military Status – Examples: Form DD214, VA Medical Center ID Card, Military Retiree Identification, Veteran Identification Data, USDVA letter verifying service.

Max. file size: 50 MB.

Proof of residency, such as a Driver’s License / State Issued I.D., or mail showing physical address.

Max. file size: 50 MB.

Background check form

Max. file size: 50 MB.

Talent Release Form/Waiver

Max. file size: 50 MB.

Liability Waiver

Max. file size: 50 MB.

Personal Reference 1

Max. file size: 50 MB.

Personal Reference 2

Max. file size: 50 MB.