Pharmacy Residency (PGY1)

Camp I-Thonka-Chi Camper Application

Want your child to be a camper at Parkland's Camp I-Thonka-Chi? We'd love to have you!

Please fill out the form below. To complete this form online, you will need to print, scan, and submit two short documents near the end of the form. If you would prefer to fill out the entire form by hand and send it by fax or mail, please download the Camper Application PDF. Download the Camper Release PDF here. 

After we receive your camper application, a welcome packet will be mailed to the camper approximately 1-3 weeks prior to camp. This packet will include items to bring to camp, details when dropping off and picking up your child, etc.

For questions, contact:

Donna Crump - 214-590-2562 | Donna.Crump@phhs.org
- or -
Rosa Garces - 469-419-5533 | Rosa.Garces@phhs.org


* indicates required field

Camper Application

**Must be completed by the parent or legal guardian**
* Child’s Full Name
* Age
* Sex
Gender
Nickname/Preferred Name
* Grade in School
* Date of Birth (MM/DD/YYYY)
  Child's cell phone
Child's email address
  Confirm Child's email
* Child’s Primary Language


If you selected 'Other' above, please specify:
* Contact Email Address
* Confirm Email Address
* Transportation to camp
* T-Shirt Size (adult sizes)




Parent/Legal Guardian Information

**Please fill out any of the following, if different from your child’s information stated clearly above**
* Parent/Guardian Name
* Parent's Primary Language


If you selected 'Other' above, please specify:
* Relationship to Child
* Child lives with this person
* Address
* City
* State
* ZIP
* Home Phone
* Cell Phone
Work Phone
* Employer
Parent email address
Confirm parent email address

Additional Parent/Guardian Information
Parent/Guardian Name
Parent's Primary Language


If you selected 'Other' above, please specify:
Relationship to Child
Child lives with this person
Address
City
State
ZIP
Home Phone
Cell Phone
Work Phone
Employer
Parent email address
Parent email address

Emergency contacts
(contacts outside of your home)

1. * Name
* Relationship to Child
* Phone
Alternative Phone
2. * Name
* Relationship to Child
* Phone
Alternative Phone
3. * Name
* Relationship to Child
* Phone
Alternative Phone

Child care information

My child has



If your child has been to another sleep-away camp, where was that?
If your child has slept away from family before, how often is that?
If your child has any fears, please describe:
Has your child experienced any recent or is still dealing with any life changes/stressful events?
(divorce, death, peer or school pressure, remarriage, new home, bullying, a learning disability, alcohol/drug/tobacco use, etc.):
* Assistance






Additional Information (special needs, routines, etc.):
* Sleep Habits








Describe any unusual bedtime and sleep habits (sleepwalking, waking up, nightmares, bedwetting, etc.):
Socialization







Additional Information:
* Water Activity









Additional Information