Active with Asthma Camp

1. Please complete application below with the CAMPER'S information. And if the camper is eligible, the American Lung Association in Wisconsin will send the registration packet (medical forms and additional information required) for Active with Asthma Camp.

*

Name:

 

 

   

*

 

*

City/State/ZIP:

 

    

*

*

Date of Birth:

 

If you respond and have not already registered, you will receive periodic updates and communications from American Lung Association.

 

What's this?

 

Please provide the information below with the Parent/Guardian's information:

*2.  


*3.  


*4.  


*5.  


*6.


7.

*8.


9.

 

Camp registration is $80. A $20 deposit is required with completed application and will be refunded if child is not accepted. Scholarships are available based on need.

 

*10.


   Please leave this field empty