Please complete this form, verify its accuracy, and then click the Submit button. This information assists us in selecting participants who can successfully complete and benefit from a Camp Resilience session and in planning appropriate activities. Your participation during Camp Resilience will afford you the opportunity to engage in activities that are physically demanding and emotionally draining. It is important that you accurately complete this form to maximize the benefits of Camp Resilience.
By submitting this form, you are confirming that you have provided all the information that is requested and that you have no medical or other restrictions that you have not disclosed that would interfere with your participation.
After the review of the application, PRLI reserves the right to request that you provide a release of information form to your physician or therapist so we can get confirmation that you are physically, emotionally and psychologically able to participate in a Camp Resilience session.