Sign Up to Participate

You may sign up one child per form. Once you click submit, you will be given an option to register another child. Thank you for your interest in Kathy's Camp!

Child's full name:

Child's birth date (mo/day/year):

Parent/Caregiver's full name:

Parent/Caregiver's email:

Parent/Caregiver's phone:

Family member diagnosed with cancer (mother, father, primary caregiver):

Type of cancer:

Treatment status:


Treatment facility (where you are getting or have received treatment):

Message or questions: (optional)

 

Participate