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FitQuest Family Camp Registration 19/20
Step 1 of 4
25%
Brought to You by Sutter Health Valley Area and Shady Creek Outdoor Education Foundation
) is a free program with limited room for participation. Applicants chosen to participate will be contacted directly. Participation acceptance covers program, lodging, meals, and provided transportation fees that will be paid directly to Shady Creek Outdoor Program on the participant’s behalf.
Description:
Shady Creek staff will facilitate experiential learning in nutrition and physical fitness focused workshops, activities and programs. The goal of the weekend is to educate the family unit on the benefits of:
Healthy meals and snacks as a choice
Family fun and fitness (through physical activity)
Self-confidence and positive body image
Eligibility Criteria Includes:
Maximum family participation of eight (must include 2 adults for more than 2 children).
For children(s) 2-17 years of age. (Child care will be provided for children age 2-5 during instructional periods.)
At least one child must have participated in the Shady Creek Outdoor School program during the current school year.
The ability to get to and from the transportation pick-up site (transportation from Yuba City and Marysville to Shady Creek Outdoor School and back will be provided at no cost).
The ability to provide for family participants the necessary items for the weekend as described in the ‘What to Bring’ list (provided separately).
Description of why the Fit Quest Family Camp program could be a benefit to your family.
Applicant Family Information
Contact Name
*
First
Middle Initial
Last
Address
*
City
*
Zip Code
*
County
*
Phone Number
*
Email
*
Is your mailing address different from the above?
*
No
Yes
Mail to:
*
Address
*
Street Address
City
Zip Code
Total Number of Participating Family Members
*
Please enter a number less than or equal to
6
.
Participant 1 Name
*
Age
*
Relationship
*
Participant 2 Name
*
Age
*
Relationship
*
Participant 3 Name
*
Age
*
Relationship
*
Participant 4 Name
*
Age
*
Relationship
*
Participant 5 Name
*
Age
*
Relationship
*
Participant 6 Name
*
Age
*
Relationship
*
Family Eligibility
Name of Student Participating in Shady Creek Outdoor School
*
School Name
*
Name of Student's Teacher
*
Date Attended Shady Creek Outdoor School
*
MM
DD
YYYY
The Family will need transportation from the pick-up location for Family Camp to and from the Shady Creek Outdoor School?
*
No
Yes
The Family will be able to provide the necessary items for all participating family members as described in the “What to Bring” list?
*
No
Yes
The Family agrees to participate in the entire Friday – Sunday weekend program?
*
No
Yes
Benefit to Family
Describe why participating in the Fit Quest Family Camp could be a benefit to your family
Attach a separate document below, if needed.
Upload file to answer the above question
Accepted file types: doc, docx, pdf.
doc, docx, or pdf files only
We are applying for consideration for Family Camp, date:
*
If the date of your county does not work, please feel free to sign up for for the other Family Camp.
July 10-12, 2020 Yuba-Sutter Counties)
July 24-26, 2020 (Placer-Sacramento Counties)
Applicant(s) signature(s) confirms that he/she is the legal parent or guardian of all children included in this application and that they have the legal authority to make decisions regarding their healthcare and inclusion in this program.
Type Name
*
Signature
*
Date
*
MM
DD
YYYY
Type Name
Signature
Date
MM
DD
YYYY
