Register for Camp Kangaroo NameThis field is for validation purposes and should be left unchanged.Select Camp Location(Required)Please SelectHouston, TXCalifornia - Los Angeles and Orange CountyTreasure Coast, FLBroward County, FLHillsborough County, FLPinellas County, FLPasco County, FLHernando County, FLIllinoisMarylandHow did you hear about Camp Kangaroo?Name of child attending Camp Kangaroo(Required)Child's current age(Required)Child's Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Adult contact name(Required)Who should we contact with information about Camp?Contact's phone number(Required)Contact's email address(Required)Emergency contact for child during Camp(Required)Please list any Allergies(Required)Please list any medical conditions(Required)Special person(s) who died - please list full name(Required)Special person's relationship to the camper(Required)Age of camper at the time of loss(Required)Please briefly describe the relationship between the camper & the deceasedDoes your camper have difficulty with any of the following? Sleeping Eating School Relationships check all that applyDid your camper reside with the person who died?(Required) Yes No Does your camper receive meals from school free of charge?(Required) Yes No Are there any language, disability or other needs, family customs or cultural aspects to the campers grieving that we should be aware of?Please provide us with any other information about your camper that will be helpful in providing a supportive camp experience.Gender(Required) Male Female Non-Binary T shirt size (adult sizes(Required) XSmall Small Medium Large XL XXL CAPTCHA
