1st Quarter Respite Registration 2018 Question Title * 1. Camper First and Last NamePlease double check spelling before submitting. Question Title * 2. Have you sent in your...*we must have all of these items before you can fill out this form* ****Application (Please do the 2018 Application. All individuals wishing to attend weekend respite are required to complete a 2018 application prior to being processed for registration. Thank you for your cooperation.)*** Immunization Records and Health History Form Physical (valid for 2 years) 3 Signed Waiver Forms (located in the application) CCSP or ICP from your case manager Funding (Notice of Decision or private payment) Case manager's email address Question Title * 3. Please choose the 1st Quarter respite sessions you would like to request(2nd quarter dates will open March 1st) R1 Camp Sunnyside's Got Talent (January 5-7) R2 Mission Possible (January 19-21) R3 Valentine's (February 2-4) R4 Up, Up, and Away (February 16-18) R5 Amazing Race (March 2-4) R6 Camp Sunnyside Olympics (March 23-25) By submitting this form, you understand that this is a request for the dates listed and NOT a confirmation that you have been registered. You will receive a letter in the mail that will show whether you have been confirmed or added to the waitlist. Question Title * 4. Person filling out survey? Case Manager Guardian Other (please specify) Submit