Trip Camp Registration Form 2020 Travel Trip Camp Spend the week enjoying sights and sounds of outdoor recreation while camping in State & National Parks! Campers need Camper Name: ______to be able to function on a strict 1:4 staff to camper ratio, be able to take care of their own personal care needs, and have no Parent/Guardian: ______current tendency of wandering, running, or aggression to self or others. First-time trip campers must be interviewed and DOB: ______/______/______Age: ______Gender: M / F approved by Program Staff for Travel Trips. Campers must have attended Camp K Residential camp at least one time prior to attending Trip Camp, unless otherwise authorized. Minimum age to attend trip camp is 14 years old. Address: ______City: ______St: ______Zip: ______Basic hygiene needs will be met and access to showers will be limited. **Some Campgrounds do not have electrical outlets. All personal & medical equipment required for camper must be Main Phone: ______battery powered . Camp K does not guarantee electrical outlets at campgrounds and does not provide batteries. Secondary Phone: ______Trip camps include hiking on uneven surfaces. Due to this ,we are unable to accommodate campers that utilize Email: ______wheelchairs. Sleeping arrangements include sleeping in a tent with a group at a campground. Sleeping pads will not be provided. For special diets, campers are required to bring their own food, which will need to be arranged with **Mark boxes on back to register** program staff.** Has camper attended Camp K Summer Camp in the past? Travel Trips are subject to change. Scheduled activities are contingent upon weather, emergencies, etc. Yes / No Canceled activities will not be rescheduled. T-Shirt size: Youth: SM MED LG XL **Drop off is at 8:00-8:30am on Monday morning. Please keep in mind this is the first day of camp and could take up to one Adult: SM MED LG XL 2XL hour to properly check-in. All Parents/Guardians MUST stay with their camper until the full check-in process is complete. Pick-up time is 1:00-1:30pm on Friday. A $50 fee will be added if camper is not picked up by 1:30pm and for each 30 COST minutes thereafter.* $925.00 per week to be paid at the time of registration

By completing this registration form, you agree that if the camper is sent home for endangering the safety of themselves, staff or campers, there is no refund of the camp fee.

*In case of cancellation, there is a $250.00 cancellation fee* *Camp K will assess a $30 fee for all checks that are returned*

PAYMENT METHOD Check - Amount Enclosed: $______DSPD Funds- Caseworker Name & Phone #: ______Credit Card - Amount to charge: $______I would like to apply for financial assistance. Enclosed Important Information is the $250 minimum required fee. Camp reservations are on a first-come, first-served basis. The supervision ratio is one counselor for every four campers. Nurses are present during check-in to create a med log and are on call during the week for medical advice. Financial aid/ Card #: secondary scholarships are available to those who qualify. If awarded the scholarship, it will only be applied to one week. All Exp Date: Zip Code: CVS/CVC: campers must be free from illnesses at time of check-in. Any camper with a history of seizures must wear a life jacket during all water activities. Due to county safety standards, all campers who have a history of incontinence or a recent Signature: sickness must wear swim diapers in the pool. Camp K does not provide these, but they may be purchased at any medical supply store and some drug stores. Campers may be sent home at any time for illness or behavior issues towards themselves, other campers, or staff, and there will be no refund of the camp fee. If you have any questions, please contact our office at [email protected] or (801) 582-0700 ext. 100 or 108

*All money received is non-refundable. Cancellations made eight weeks prior to start date will be eligible for credit, OFFICE USE ONLY less the cancelation fee. Any cancellations made within eight weeks of the start date will not be eligible for any Amount Received:$______credit* *Should DSPD deny payment, you are responsible to pay the cost of the program* Date Received:______/______/______

*Camp Kostopulos is accredited by the American Camp Association, an agency that sets standards and reviews camp Check#: ______operations across the U.S.* Travel Trip Camp TRAVEL TRIP CAMP *NEW* Please number boxes by preference, #1 starting as 1st Sun Valley, Idaho choice. If you would like to attend more than one week, 2020 Week 6: July 13th-17th please indicate below by numbering the box & indicate in This newly added destination is sure to strike chord for the blank line how many weeks you would like to attend. Salt Lake Valley adventurers of all sorts! Travel with Camp K to Sun Valley Idaho for incredible views of the Sawtooth Mountain Range, Shoshone I would like to request to attend ______Week 1: June 8th-12th Falls, and visit the Mammoth Cave & Shoshone Bird Museum of the marked weeks below. Start the summer off with adventure! Camp K’s Travel Trip will Of Natural History. journey to many sites around the valley, such as Clark Week 1: Salt Lake Valley Planetarium, hiking in the Wasatch Mountains, swimming, and (June 8-12) more. Come enjoy all the the Salt Lake Valley has to offer! Yellowstone National Park Week 2: Bryce Canyon & Capitol Reef Week 7: July 20th-24th (June 15-19) Bryce Canyon & Capitol Reef Take a trip to Yellowstone National Park to experience dramatic Week 2: June 15th-19th canyons, alpine rivers, lush forests, majestic wildlife, and Week 3: Durango, Colorado This trip offers the opportunity to explore and witness the natural gushing geysers! During this trip, we will explore some of the (June 22-26) beauty of two of Utah’s National Parks! While visiting the parks, most popular natural spectacles in the nation- including Old Faithful and the Grand Canyon of Yellowstone. Week 3: Park City & Heber Valley we will take multiple scenic hikes to waterfalls, caves, red rock arch formations, and witness the largest concentration of (June 22-26) Hoodoos on Earth. We will also learn about the unique Week 4: Lava Hot Springs & Antelope Island landscapes of this area and participate in a variety of activities. Salt Lake Valley Week 8: July 27th-31st (June 29– July 3) Come enjoy beautiful scenery and amazing activities with Camp Week 5: Jackson Hole, WY K, as we explore our community and camp in the nature nearby! *NEW* Activities may include hiking, swimming, , as well attending (July 6-10) Durango, Colorado sporting and community events. During this week, we will Week 6: Sun Valley, Idaho Week 3: June 22nd-26th explore different places such as, Hogle Zoo, Natural History (July 13-17) Adventure to the historic town of Durango, Colorado! We will be Museum of Utah, and more! traveling to the Mesa Verde National Park– known for its well- Week 7: Yellowstone preserved Ancestral Puebloan cliff dwellings and nearly 5,000 Bear Lake known archeological sites! Hiking and scenic views in the San (July 20-24) Week 9: August 3rd-7th Week 8: Salt Lake Valley Juan National Forest are also highlights for trip campers along for this journey! They call it “The Caribbean of the Rockies”—Travel with Camp (July 27-31) K to Bear Lake! Here we will explore Minnetonka Cave, which features a half-mile of fascinating stalactites, stalagmites, and Week 9: Bear Lake Park City & Heber Valley banded travertine, as well as seeing fossils on display at the (August 3-7) Fossil Butte National Monument. Campers are sure to enjoy a Week 3: June 22nd-26th soak in the Bear Lake Hot Springs and a relaxing afternoon on Registrations are processed by date received. If the Join Camp K in one of Utah’s most popular tourist destinations. the beach. week you request is full, we will contact you. Spend the nights camping in Oakley, UT and the days exploring Additional paperwork will be sent after registration is the Park City and Heber Valleys. We will take advantage of the completed. beautiful area by visiting Mirror Lake and hiking around Park City! All aboard as we travel via the Heber Valley Railroad for one-of-a- kind views and sights!

Trip Camp Cost Lava Hot Springs & Antelope Island The actual cost for one camper to attend a week of Week 4: June 29th-July 3rd Trip camp is $2,000.00. Camp K works year-round to Soak in the warm, mineral-rich waters of Lava Hot Springs, as be able to provide scholarships for each camper who well as explore natural treasures located in Northern Utah; attends. The scholarship amount for Trip Camp is including the Soda Spring Geyser, the only captive geyser in the $1,075.00, bringing the cost to for families to world! We will then travel to Antelope Island, taking in the sights *Please Note:* $925.00 of free-ranging bison and many other desert animals. This is sure All participants attending a Travel Trip to a to be a week of excitement and fun-filled, outdoor activities! National Park must get their own “Access Pass” Please send payment & registration to: before attending trip camp.

Kostopulos Dream Foundation Jackson Hole, Wyoming These passes are free for individuals with disabilities and 4180 Emigration Canyon Rd. Week 5: July 6th-10th can be obtained at the Salt Lake City, UT 84108 Camp in view of the breathtaking Grand Teton Mountains as we BLM Office: 440 W 200 S, SLC, UT Suite 500. [email protected] travel to Jackson Hole, Wyoming! We will tour around the historic town of Jackson Hole, visit the Grand Teton National Park, and Please call BLM (801-539-4001) or visit their website to hike to scenic views of the area. This is a must-attend trip of the ensure that you have the necessary documents. Office (801) 582-0700 | Fax (801) 583-5176 summer!