CAMP APPLICATION AND HEALTH STATEMENT

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Parent or Guardian's EmailFirstLastGenderBirthdayNext GradeAddressGuardianRelationshipPhoneEmergencyRelationshipPhoneCongregationCabin RequestT-Shirt Size (adult sizes only)PhysicianPhoneAllergies, Medications and ConditionsNon-Participating Activities:OTC MedicationsDate of Last Tetanus shot:Can this camper swim?Medical and Emergency ConsentMedia ConsentElectronic SignatureDatePayment AmountPayment Date
Email hidden; Javascript is required.jaydaSandroniFemale05/13/201289148 Suncoast Terrace
Hudson, FL 34667
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Brittany sandroniMother7273331121Angelo sandroniFather3527709740Grace FamilyGirl's Cabin 4XXLKids care7278635474
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
05/10/2024Yes I agree I agree05/06/2025$175.00May 6, 2025
Email hidden; Javascript is required.BryanMartinMale07/28/1989125982 106th Terr N
Pinellas Park, FL 33782
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Phillip MartinFather7274602848Diane MartinMother7274925073Pinellas Park CoCBoy's Cabin 4XLPhillip Martin7274602848
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
05/01/2025Yes I agree I agree05/07/2025$175.00May 7, 2025
Email hidden; Javascript is required.arielkostaresFemale12/19/20136th13429 carol dr
hudson, fl 34667
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paul kostares727-919-39147272716966katie kostaresmom7272716966ccwcGirl's Cabin 4Mdr fellgoodstine7271339966
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
05/07/2025Yes I agree I agree05/07/2025$175.00May 7, 2025
Email hidden; Javascript is required.JoshuaEzellMale07/16/2006Post high school377 Corders Crossroads Rd
Fayetteville, Tn 37334
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Jeremy EzellFather9319930293Juli EzellMother9319938378Washington St CoCBoy's Cabin 3MDr. Gafford9314337778

Allergic to tree nuts
Aderal
Sertraline

No

  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
07/10/2018Yes I agree I agree05/07/2025$175.00May 7, 2025
Email hidden; Javascript is required.KassandraHernandezFemale06/18/2008124051 Dalwood Dr
Holiday, Fl 34691
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Heylin AlvarezAunt4073759265Jennyfer PerezMother4077643031Trinity Church of ChristGirl's Cabin 2XLKassandra8632421474
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
04/15/2020Yes I agree I agree05/07/2025$175.00May 7, 2025
Email hidden; Javascript is required.KaiMartinMale02/18/20101010937 92nd st
Seminole, Fl 33777
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Tim MartinDad(727) 687-3732Colleen MartinStep mom(630) 248-7339CentralBoy's Cabin 4LShayne M. Gadea, MD(727) 391-0158
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
07/02/2020Yes I agree I agree05/08/2025$175.00May 8, 2025
Email hidden; Javascript is required.KennedyPenn - RobertsonFemale01/29/2015510222 Widgeon Way
New Port Richey, Fl 34654
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Kasey RobertsonMom(727) 277-0934Adam RobertsonDad(727) 484-5758Trinity Church of ChristGirl's Cabin 1MAllesha Pinero(727) 376-4040

Watermelon allergy. ADHD Medication

No

  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
01/29/2023Yes I agree I agree05/08/2025
Email hidden; Javascript is required.PeytonPenn - RobertsonFemale01/11/2016210222 Widgeon way
New port Richey, Fl 34654
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Kasey RobertsonMom(727) 277-0934Adam RobertsonDad(727) 484-5758Trinity Church of ChristGirl's Cabin 1MAllesha Pinera(727) 376-4040

AUTISM*** on ADHD medication and sleep medication

No limitations but she does need to be accompanied by an adult at all times. (I’m so nervous 😬) please put her in the same cabin as her sister Kennedy

  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
01/29/2023Yes I agree I agree05/08/2025
Email hidden; Javascript is required.EastonPenn - RobertsonMale01/11/2016310222 Widgeon Way
New Port Richey, Fl 34654
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Kasey RobertsonMom(727) 277-0934Adam RobertsonDad(727) 484-5758Trinity Church of ChristBoy's Cabin 3MAllesha Pinero(727) 376-4040
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
01/29/2023Yes I agree I agree05/08/2025
Email hidden; Javascript is required.LilyByrneFemale10/08/20109435 3rd Ave n
Saint Petersburg, Fl 33708
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JennaMom(727) 919-1374CaseyDad(727) 307-0010PinellasBoy's Cabin 3SRichardson(727) 381-1147
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
05/22/2024Yes I agree I agree05/09/2025$175.00May 9, 2025
Email hidden; Javascript is required.RheaByrneFemale08/22/20154435 3rd Ave n
Saint Petersburg, Fl 33601
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JennaMom(727) 919-1374CaseyDad(727) 307-0010PinellasGirl's Cabin 1XSDr Richardson(727) 381-1147

She takes a pill for epilepsy each morning and night. She had emergency meds and doesn’t need them

No

  • Tylenol
  • Ibuprofen
  • Tums
05/23/2024Yes I agree I agree05/09/2025$175.00May 9, 2025
Email hidden; Javascript is required.AdryannaBohdyFemale01/01/201110125 Locust Run
Ocala, FL 34472
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veronica bodaymother(440) 984-8391Charles Bohdyfather(440) 219-1606pentacostalGirl's Cabin 3MDr. Littel(352) 414-5990
  • Tylenol
  • Benadryl
  • Tums
  • Hydrocortisone
09/12/2019Yes I agree I agree05/10/2025$175.00May 10, 2025
Email hidden; Javascript is required.SkylarPenrodFemale02/13/20137125 Locust Run
Ocala, FL 34472
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jeniya penrodmother(305) 333-0603veronica bodayaunt(440) 219-1606pentacostalGirl's Cabin 3Ssusan leitner(305) 532-3378
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
03/20/2018Yes I agree I agree05/10/2025$175.00May 10, 2025
Email hidden; Javascript is required.GiovanniReyesMale09/29/202598455 Sunset Harbor Ct
New Port Richey, FL 34653
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Misael ReyesFather(813) 638-2130Leylin ReyesMother(727) 271-7300Trinity Church of ChristBoy's Cabin 3SGiovanni Reyes(727) 717-0465
  • Tylenol
  • Ibuprofen
09/20/2024Yes I agree I agree05/11/2025
Email hidden; Javascript is required.CristalinAlvarezFemale07/03/20145 grade1484 classic dr
holiday, FL 34691
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Cristalin AlvarezMother(321) 746-6041Fernando VázquezFather(321) 746-6014TrinityBoy's Cabin 3MAlfred Alvarez(727) 376-8404
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Hydrocortisone
07/03/2024Yes I agree I agree05/11/2025
Email hidden; Javascript is required.AngeloSanchezMale01/02/201364051 Dalwood Dr
Holiday, FL 34691
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Heylin AlvarezMother(407) 375-9265Mario G SanchezFather(407) 319-0159Trinity Church of ChristBoy's Cabin 3XSDr. Alvarez(727) 376-8404
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
08/13/2024Yes I agree I agree05/11/2025
Email hidden; Javascript is required.Mario SebastianSanchezMale07/12/2008124051 Dalwood Dr
Holiday, FL 34691
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Heylin AlvarezMother(407) 375-9265Mario G SanchezFather(407) 319-0159Trinity Church of ChristBoy's Cabin 3XLDr.Alvarez(727) 376-8404
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
08/13/2024Yes I agree I agree05/11/2025
Email hidden; Javascript is required.JamesRingFemale12/08/20118th5404 Admiral Way
OXFORD, FL 34484
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Laura RingMom(352) 446-4667Ed BeckGrandfather(317) 439-0968Wings of FaithGirl's Cabin 3MDenise Chandler(352) 303-1833
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
12/03/2024Yes I agree I agree05/11/2025$175.00May 11, 2025
Email hidden; Javascript is required.CalebRingMale05/30/20146th5404 Admiral Way
OXFORD, FL 34484
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Laura RingMom(352) 446-4667Ed BeckGrandfather(317) 439-0968Wings of FaithBoy's Cabin 3MDenise Chandler(352) 303-1833
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
12/03/2024Yes I agree I agree05/11/2025$175.00May 11, 2025
Email hidden; Javascript is required.CharitySchraderFemale02/25/2014511032 Pine Tree Ln
Port Richey, FL 34668
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Charity SchraderMom(727) 389-6090Tim ellisDad(727) 267-9968Gulf viewGirl's Cabin 4MDr dondero(727) 844-3551
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
06/01/2023Yes I agree I agree05/11/2025$175.00May 11, 2025
Email hidden; Javascript is required.AddysonBlankinshipFemale06/08/201191202 E Palifox Street
Tampa, Florida 33603
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Brian J BlankinshipFather(813) 452-1720Jerry BlankinshipGrandfather(417) 499-0008Trinity church of ChristGirl's Cabin 2STeena Hughes, MD(813) 903-0060
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
02/02/2016Yes I agree I agree05/12/2025
Email hidden; Javascript is required.AnnabelleTurneyFemale01/08/20145th220 Sawyer Avenue
Spring Hill, FL 34608
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Danielle TurneyMother(727) 953-0390CharliannAunt(727) 678-5310Trinity Church of ChristGirl's Cabin 4SDr ward(352) 597-7373
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
01/08/2024Yes I agree I agree05/12/2025
Email hidden; Javascript is required.AbigailTurneyFemale09/01/200911220 Sawyer Avenue
Spring Hill, FL 34608
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Danielle TurneyMother(727) 953-0390CharliannAunt(727) 678-5310Trinity Church of ChristGirl's Cabin 4SDr ward(352) 578-7373
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
09/01/2013Yes I agree I agree05/12/2025
Email hidden; Javascript is required.AlannaTurneyFemale02/18/200812220 Sawyer Avenue
Spring Hill, FL 34608
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Danielle TurneyMother(727) 953-0390CharliannAunt(727) 678-5310Trinity Church of ChristGirl's Cabin 4SDr. Ward(352) 578-7373
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
09/02/2013Yes I agree I agree05/12/2025
Email hidden; Javascript is required.MikelaBohdyFemale08/26/20129125 Locust Run
Ocala, FL 34472
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charlles bohdyfather(440) 219-1606jeniya penrodaunt(305) 333-0603pentacostalGirl's Cabin 3SDr Litell(352) 414-5990
  • Tylenol
  • Ibuprofen
  • Benadryl
  • Tums
  • Hydrocortisone
09/23/2019Yes I agree I agree04/29/2025$175.00May 15, 2025
Parent or Guardian's EmailFirstLastGenderBirthdayNext GradeAddressGuardianRelationshipPhoneEmergencyRelationshipPhoneCongregationCabin RequestT-Shirt Size (adult sizes only)PhysicianPhoneAllergies, Medications and ConditionsNon-Participating Activities:OTC MedicationsDate of Last Tetanus shot:Can this camper swim?Medical and Emergency ConsentMedia ConsentElectronic SignatureDatePayment AmountPayment Date