Wings Camp - Camper Application

2025 Wings Camp

Camper Application

The staff of 3HC is really looking forward to meeting you. To help you have the best time possible at camp, we would like to know a little about you before you get here! Please complete the form and attach a picture of yourself if possible.

Which Wings Camp would you like to attend?

August 22-24, 2025 - Trinity Center Pine Knoll Shores, NC

September 26-28, 2025 - Camp Agape Fuquay Varina, NC

Name

First Last

Like to be called:

First

Gender

Age

Date of Birth

Who do you live with?(Required)

Parents

Guardians

Relationship to Camper

Parents/Guardian's Full Name(Required)

Parent/Guardian's Email(Required)

Home Phone(Required)

Cell Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3HC may communicate with parents/guardians using this email address

Yes

T-Shirt Size

What school do you attend?

Grade

How did you hear about WINGS Camp?

Favorite School Subjects:

Hobbies

Sports

Do you like arts & crafts? What are your favorites?

Do you have a Faith Tradition?

Favorite Entertainers

Favorite Music

Brothers & Sisters and their ages

Do you have pets?

How well can you swim?

Are there any other special things we should know to make your time at Wings more comfortable?

Your Loved One

Name of lost loved one

Relationship to camper

Cause of death

Year of loss

EMERGENCY CONTACT INFORMATION

Name

First Last

Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone Number(Required)

Secondary Phone Number

In addition to parent/guardian, who may be authorized to pick child up from camp? (Include name, relation to the child, and phone number):

MEDICAL INFORMATION

To be filled out by the parent or Physician

Physician's Name

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dentist's Name

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

RECOMMENDATIONS AND RESTRICTIONS WHILE AT WINGS CAMP

Special Diet (Please explain reasons and foods)

Physical Activity Restrictions (i.e. athletics, running, etc.)

Other

Allergies (include what the child is allergic to and what the reaction is)

Recent operations or serious illness (include dates)

Chronic or recurring illness (i.e. ear/throat infections, asthma, headaches, diabetes, convulsions, etc.

Psychiatric or behavioral problems (i.e. ADD, ADHD, depression, withdrawn, etc.)

Physical handicaps involving hearing, eyesight, or prosthesis

Media Release

To be filled out by the parent/guardian.

I hereby affirm that I am the parent/guardian of:

and I give my consent for Home Health and Hospice Care, Inc. (3HC) to use pictures, photographs, news stories, and/or audio visual of the above-mentioned minor for reproduction of the same in any form including marketing, illustration, or publication.

Printed Name of Parent/Guardian:

Date of Signature

Wings Camp – Camper Application

2025 Wings Camp

Camper Application

Your Loved One

EMERGENCY CONTACT INFORMATION

MEDICAL INFORMATION

RECOMMENDATIONS AND RESTRICTIONS WHILE AT WINGS CAMP

Media Release

Patients & Families

Health Care Professionals

Ways to Give

About Us