Camp EMS Student Application

To register for Camp EMS, please complete all information and submit form and $100 registration fee by May 26, 2017. 
Please note that submission requires student and parent verification.

A limited number of camp scholarships are available based on financial need.  If the registration fee is a prohibitive factor in attending camp, please contact Jim Kifer at 814-870-1940 to discuss scholarship options.

If yes, a letter of support from a school administrator or your probation officer MUST be submitted separately.  You will be notified of email address to send it to.

I would like to participate in Camp EMS Because

You may upload the following filetypes:  txt, rtf, odf, pdf, doc, docx

Acknowledgements & Signatures

I acknowledge that Camp EMS is a challenging and vigorous program designed to provide a robust experience that will help the participant learn about emergency medical services and career options.  I attest that the undersigned camper is physically, emotionally and mentally capable of enduring light to moderate physical activity associated with camp programs as well as sustain 8-10 hour days for the duration of camp.  I attest that all information contained within this application is accurate and true to the best of my knowledge and that as part of the Camper application process all information provided is subject to verification.  Furthermore, I understand that if it is determined that information has been withheld or that the information provided is untrue, I will automatically be disqualified from participating in Camp EMS.

I understand that EmergyCare staff make all final determinations on applicant approval.

I have read and understand the program guidelines noted on the camp brochure.

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