BAA Camp Application Form

District Name:   School Name:

Camp Be An Angel is designed to be a retreat for special needs children under the age of 22 and their immediate families (Mom, Dad, Brothers and Sisters). Only household residents that cannot be safely left at home will be allowed to register.

Please check the box below to confirm the April or July date.

April 26-28, 2019, or July 26-28, 2019

Families are selected on a needs basis with priority being given to first time campers. If the family is selected, there will be a $25 required deposit that must be sent only by check to the Be An Angel office address; 2003 Aldine Bender Rd. Houston, TX 77032.
Once the deposit is received, selected families will be sent a camper packet via email. You will need to arrange for your own transportation. At 12:00pm on Sunday, deposit checks will be returned along with a $25 gas card to help defray travel expenses. For "No Shows" that do not notify BAA at least 48 hours prior to February 1, the deposit will be forfeited.

ALL spaces must be entered in ENGLISH. No special characters can be entered in this application. The results will be an error message. Special characters include but not limited to ' ; , . / " : ?. If a space doesn't apply, enter NA.

Parent or Guardian First Name of special needs child Parent or Guardian Last Name of special needs child
Address: City: State: Zip:
Preferred Phone: - -    Email:
Please select all that apply from dropdown list at the right.

Is a wheelchair or walking assistance required? Yes    No
Is there difficulty sleeping through the night? Yes    No

Would they disturb other campers?
Please explain

Any dietary Restrictions?

Any other special considerations?

Previous camp attendance

How did you hear about camp BAA?

What financial assistance do you receive?

Please list all immediate family members (a maximum of 7) who will be attending -
including the child listed above:
(at least one parent/legal guardian must be in attendance)
First Name Last Name Age Relationship Gender TshirtSize

Thank you for your participation.