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Waitlist Application

The Camper is:

Camper Information:

Assistive devices used:
Medical History:
Does your camper need assistance with:
Camper's Preferred Mode(s) of Communication:
My child may participate in any camp-sponsored field trips away from Sertoma Camp Endeavor premises and be transported by vehicle driven by designated licensed staff.

Parent/Guardian Information:

What type of contact is this?

Emergency Contact (please make it a different person from the parent guardian listed above)

What type of contact is this?

Please submit camper physical here. Camper physicals are due by Drop off on Sunday, June 25th. If you have any issues with uploading physicals please email them to

Upload Camper Physical

Camper Tuition of $250.00 is due at the time of application. Payment will be completed on the next page.

Thank you for your applicaiton!

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