This application is available to any family who has (or has lost) a parent or child who has been or is in treatment for cancer or sickle cell anemia within the last FIVE years. Families outside of five years will be put on a wait-list. New participants and children or adults currently in treatment will be given priority. Due to limitations of space and overall capacity, only children or adults living in the same household are eligible to attend.

Applicants are accepted into Camp Good Days programs free of charge, without regard to race, ethnicity, gender, gender identity or expression, religion, national origin, disability, or sexual orientation. Final acceptance shall be determined upon review.

Please Note: Each accepted family is required to attend a virtual information session prior to arrival. You will need your health insurance information to complete this form.

* Denotes a Required Field

(If your family has more than one patient, please contact Alicia Sommer)

Please list all participants who will be attending the session



Are responsible for the actions and supervision of each child/participant throughout the program. At least one legal parent or guardian is required to attend.

All communication regarding the session will be sent to this contact (i.e. e-mail and postal mail).

Additional Adults

Please list any other adult (18 and older) living in your household who will be attending camp


Please list all dependent children (age birth to 17) attending the session

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6
(If your family has more than 6 children, please email the requested additional child information to: Alicia Sommer)

Families will have the option to either (1) be assigned to our gendered cabins, either boy or girl cabin or (2) share an assigned cabin with 1-3 other families. Our cabins are generally one large room with bunks, with a restroom off of it. There are not separate sleeping spaces. We will do our best to assign you to your preferred housing type. See the family information packet for more details.