Camp Courage Application 2017 Application for Camp Courage - 2017 Once you submit this completed application, a JourneyCare counselor will contact you to schedule a registration interview. All Camp Courage applicants and their families are required to attend a registration interview in order to be able to participate in Camp Courage. Child's Name (1)* First Last Age*Has this child previously attended Camp Courage?* Yes No If yes, in what year did this child attend?Child's Name (2) First Last AgeHas this child previously attended Camp Courage? Yes No If yes, in what year did this child attend?Name of Parent/Legal Guardian* First Last Address of Parent/Legal Guardian* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of ResidenceBooneCookDeKalbDuPageKaneKendallLakeMcHenryWillWinnebagoBest Phone Number to Reach Parent/Legal Guardian*Email of Parent/Legal Guardian* Name of Deceased Loved One* First Last Relationship to Child/Children*Approximate Month and Year of DeathHow did you hear about Camp Courage? JourneyCare website Camp Courage brochure Mailing from JourneyCare JourneyCare staff member Child's school Place of worship A friend told us about Camp Courage A family member and/or friend has attended Camp Courage EmailThis field is for validation purposes and should be left unchanged.