NEW FAMILY YEAR-ROUND APPLICATION

This application is available to any child or adult who is currently being or has been treated for cancer or sickle cell anemia and their immediate family members without regard to race, color, gender, gender identity or expression, religion, national origin, or sexual orientation. Camp Good Days strives to foster a safe, supportive and inclusive community environment for children, adults and family members to be surrounded by those who are experiencing similar life challenges.

Final acceptance into Camp Good Days’ programs shall be determined after review. Only one application is needed per family.

 

Eligibility Guidelines

Camp Good Days offers programs for children (ages 4-17), adults (18+) and families including:

  • Children who have been diagnosed with cancer or sickle cell anemia
  • Children that have a parent or sibling who has been diagnosed with cancer or sickle cell anemia
  • Children that have lost a parent or sibling with cancer or sickle cell anemia
  • Adults with Cancer

If you know an adult, child or family that would qualify for our programs refer them here.

* Denotes A Required Field

Camp Good Days has offices in Western NY, Central NY and the Finger Lakes region.


ONCOLOGY/ HEMATOLOGY PATIENT INFORMATION


Medical Center where patient was treated


FAMILY CONTACT INFORMATION (FOR PARTICIPANTS UNDER THE AGE OF 18) Parent/ Legal Guardian #1 (This person will be used as the primary contact person. Mailings, both email and postal mail will be sent to this address)


Parent/ Legal Guardian #2


Emergency Contact Information - This person will be contacted if Parent/ Legal Guardian(s) cannot be reached.


ADDITIONAL ELIGIBLE PARTICIPANTS (Note: Household Members who qualify for our programs)

INDIVIDUAL 1


INDIVIDUAL 2


INDIVIDUAL 3


INDIVIDUAL 4


HEALTH INSURANCE INFORMATION
Health Insurance (required to attend Camp Good Days programs)


ADDITIONAL INFORMATION