Camp HEAL Camper Application

Hospice of Southwest Georgia
114-A Mimosa Drive
Thomasville, GA 31792
229-584-5500/229-584-5505

Application to attend Camp H.E.A.L.
October 29, 2016; 9am-5pm
Camp Piney Woods, Thomasville, GA

Ages 6-17 (We cannot accept children under 6 years of age or over 17 years of age)

Camper Deadline is October 15, 2016 or until enrollment number is reached.

Camper space is limited.

Parent/Guardian Contact Numbers

Please list persons allowed to pick up child.  Only those with the intact armband or those on the list with picture ID may retrieve the child from camp.

Please complete all of the following information about the child attending Camp H.E.A.L.  If not applicable, please write none.