A Spiritually Gratifying
Summer Experience.
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Do not print this application. Must be filled out and submitted online. Printed applications will not be accepted

IF YOU HAVE QUESTIONS about this application, about required paperwork, other need DHS assistance: Please contact us +15164447715 or [email protected]

IF YOU HAVE QUESTIONS about available space, if your child qualifies for camp, or have other questions : Please contact the Marifah Child Placement Coordinator at [email protected]

HAVE AN ADOPTED CHILD? If a returning Marifah camper has been adopted since last year's camp, they are still allowed to attend camp with us. If they have NOT attended camp and are adopted, we will consider taking them to camp with us if we are not able to fill camp with foster children from El Paso County or Unaccompanied Refugee Minors (URMs).

TIME TO FILL OUT APP: Will take 30-40 minutes. Please fill out ENTIRELY. One application per child. Fill out and submit ONLINE ONLY. **DO NOT PRINT AND SCAN.** If you do not have Internet access - please find someone to help you fill this out online. If you're worried about your computer crashing or the app not going through, save answers as you go along in a Word Document and copy and paste into the application.

CURRENT PHOTO: You will be required to upload a current JPG photo of this child at the end of the app.

Do not print this application. Must be filled out and submitted online

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Name of Person Filling Out This Application *
Relationship To Child
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Child's Information
If child is a returning Marifah and had a DIFFERENT NAME LAST year, please let us know!
Gender *
Birthdate
Age at Time of Camp *
This child will be entering this grade in the fall of 2020.
Child's T-Shirt Size *
Is this child a returning Marifah Camp? *
If yes, what year, city, and state?
Are you interested in finding out how this child can be part of the Marifah Program throughout *
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Siblings of Child Applying to Marifah This Summer

If siblings of this child will ALSO be applying to the Marifah camp, please provide their info so we can try and get all siblings to camp this summer.

If a sibling of this child is applying to camp, please tell us who that is.
This sibling is a..
If 2nd sibling is applying to camp, please tell us who that is.
2nd sibling is a...
If 3rd sibling is applying to camp, please tell us who that is.
3rd sibling is a
If 4th sibling is applying to camp, please tell us who that is.
4th sibling is a
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Parent/Guardian Information
This home is best described as...
If this child was adopted, when did you adopt him or her?
At time of camp, how long will this child have been living in current home?
Approximately when was this child placed in the current home?
Total # foster or residential placements for child including current home
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Mailing Address (for camp correspondence)
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Parent or Legal Guardian #1 *
Best Phone Number *
This phone is a:
Parent or Legal Guardian #2 *
Parent or Legal Guardian #2 Best Phone Number
This phone is a:
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Authorized to Pick Child Up at New Life
Who is the authorized adult that will be picking this child up from New Life after camp . **Government ID required**
Cell Number for Authorized Adult #1 *
SECOND adult authorized to pick up this child from New Life. **Government ID required**
Cell Number for Authorized Adult #2 *
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Placement Agency Information
Caseworker Name *
Caseworker Phone 1 *
Caseworker Phone 2 *
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Background/Behavior Information

Please fill this out to the best of your ability. We as Marifah staff want to make sure your child has a safe, healthy, fun time at camp. This information is extremely helpful!

How often does this child wet the bed at night? *
How often does this child wet the bed at night? *
Does this child bite other children or adults? *
Does the child deal with any of the following eating disorders or issues around food? *
How often has this child start (non-campfire) fires? *
How would you describe this child's hyperactivity? *
How would you describe this attention span? *
Please let us know if any of the following learning difficulties exist for this child.
How often does your child lie? *
Please let us know how often your child has night terrors. *
Please let us know how often your child has nightmares. *
Please let us know how often this child runs away from a situation or from home. *
Please let us know if - or how - this child may act out sexually. *
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HISTORY/STORY: Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!
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APPLICATION CHECKLIST

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