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Red Ribbon Trails

(A program of FCAN)

Family Application Form  

Check one:

All information will be held confidential and used only for the camper selection process and reporting purposes. Names and contact information will not be used for reporting purposes.  Please fill out this form and list all names of family members who will be attending the retreat/camp. Please remember that submitting an application does not guarantee an invitation to the retreat/camp.







(please specify)








Family members applying to attend the retreat/camp

Parent(s) or Legal Guardians Age Gender Relationship to family

Children living in the same household of the above parent(s) or guardian(s)

Children Age Gender Relationship to family

Family mailing address: Please provide a complete address

Address Apt. #
City State
 
Cell
 

HIV case manager

Agency

Phone number Ext.

How did you hear about Red Ribbon Trails?

Please tell us why you are interested in attending Red Ribbon Trails camp.

Do you plan to attend another camp this year?

Do you have people to talk to about your status?

Have you ever had an open case with DCFS?

If yes, is your case still open? 

Are you currently receiving TANF?

If yes, please include your case number: 
(This information is required for funding purposes.)