Camper Application


Thank you for your interest in registering for our 2021 camp program!
June, 20- 25 @ Miracle Ranch in Port Orchard.

Because of the pandemic, we will determine our programming in late April.
Our most likely option is a three day overnight camp, operating at half capacity for social distancing purposes. 

We will be able to run two separate programs that week in order to bring the maximum number of siblings possible. 

The deadline for applications will be April 20th. 
All campers will be notified by email.

Please complete the application below for each potential camper you are registering. You will be contacted in April with more details regarding camp. Thank you for your patience as we are all navigating this process. We are looking to getting back to the work of reuniting separated siblings!


Questions can be directed to our Camper Coordinator, Bob Partlow at bob@camptobelongwa.org or by calling (360)528-9025.







General Information:


Camper & Caregiver Information:


Camper / Applicant Information:


Caregiver contact Information:

In the event we need to reach you:

Social Worker Information:


Sibling Information:


Please list the name, age, gender and caregiver information for each sibling that will be applying to attend camp with this applicant. Please share as much information as possible.



Getting to know the camper:


The following questions help us to know what behavior issues your camper has so we can make sure they can have the best camp experience!

Has this child ever been diagnosed or experienced a problem with the following concerns.


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