Camp Application - Be an Angel

Be An Angel Camp Application

Families are selected on a needs basis with priority being given to first time campers. If the family is selected, we ask you to send a $25 required deposit either by check or money order (payable to Be An Angel) to our office address; 2003 Aldine Bender Rd. Houston, TX 77032.
Once the deposit is received, selected families will be sent a camper information packet via email. You will need to arrange for your own transportation. At 12:00pm on Sunday, the last day of camp, 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 the start of camp, the deposit will be forfeited.
Please Select Which Camp Date/Location You Wish To Register*
- April 24th, 25th, & 26th in Burton, Texas
- July 24th, 25th, & 26th in Rockport, Texas
Name of Disabled Child*
First Last
Age of Child*
(age limit 21 years old)
Please enter a number from 0 to 21.
Gender*
School District*
School Name*
Name of Parent/Gaurdian*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Name of County
Phone*
Email
Ethnicity
This information is used only for Be An Angel to apply for more grants to receive more donations. Ethnicity is not used for screening, selection, or any other similar uses. In order to be inclusive of mixed race families, we ask that you provide the number of family members that apply to each.
Caucasian
Hispanic
African American
Asian
Other
Handicapping Condition(s)*
Please select all that apply
- Autism
- Cerebral Palsy
- Hearing Impaired
- Orthopedic impairment
- Other health impairment
- Physical disability
- Speech impairment
- Traumatic brain injury
- Visual impairment
- Intellectually disabled/ID
- Multiple disabilities/MI (Multiply impaired)
- Non categorical early childhood
- Muscular Dystrophy
Is a wheelchair or walking assistance required?*
- Yes
- No
Is there difficulty sleeping through the night?
- Yes
- No
Would they possibly disturb other campers?
If so, please explain
Previous camp attendance
(in years)
Please enter a number from 0 to 10.

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)

To add another row for additional family members, click on the "+" icon to the right

First Name	Last Name	Age	Relationship	Gender	T-Shirt Size

Total Number of Family Members Attending
Please list any dietary restrictions
Are there any other special considerations that we should know about?
Please list any financial assistance that you receive
if applicable
How did you hear about Camp Be An Angel?*

Be An Angel Camp Application

Families are selected on a needs basis with priority being given to first time campers. If the family is selected, we ask you to send a $25 required deposit either by check or money order (payable to Be An Angel) to our office address; 2003 Aldine Bender Rd. Houston, TX 77032.

Ethnicity