Menu
Our Camp
What We Do
History
Staff/Board of Directors
Financial
Offices
Employment
Our Programs
Programs for Children
Adult Oncology Programs
Community Programs
Events
Calendar
Community Fundraisers
Cycle for Hope
FM Dance Marathon
Teddi Dance for Love
Tour de Teddi
Tournament of Love
Wine & Spirits Auction Dinner
World's Largest Disco
Regions
Central NY
Rochester, NY
Western NY
Media
Press Contacts
In the News
Digital Assets
Camp Map
Photo Gallery
Founder's Blog
Radio Show
Ways to Give
Good Days Givers (Monthly Giving)
Fundraisers
Virtual Kazoo Fest
Cookbook
Community Fundraisers
Ugly Sweater Contest
Planned Giving
Corporate Engagement
Donate Now
Donate Today
Become a Volunteer
Eligible Camper's Name:
*Street Address:
*City:
State:
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Price Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
*Zip:
Region:
Buffalo
Rochester
Syracuse
Out-Of-State
*Phone:
*Email:
Have you ever attended a Women's Oncology Program with Camp Good Days?
Yes
No
*T-Shirt Size Camper
Small
Medium
Large
X-Large
XX-Large
XXX-Large
*Date of Birth:
Gender - Camper
Diagnosis:
Diagnosis Date:
Date or Year of Relapse:
Date of Last Treatment:
*Name Of Spouse / Support Person:
*Email - Spouse / Support Person:
*Date of Birth - Spouse / Support Person:
Gender - Spouse:
Male
Female
T-Shirt Size Spouse
Small
Medium
Large
X-Large
XX-Large
XXX-Large
MEDICAL INSURANCE INFORMATION (Required To Attend Camp Good Days)
*Health Insurance Carrier:
Policy Holder:
*Policy #:
Group ID #
Additional Insurance Information (if family members have different policies):
Processing...
Buffalo
Syracuse
Rochester
Buffalo Newsletter
Signup
Processing...
Syracuse Newsletter
Signup
Processing...
Rochester Newsletter
Signup
Processing...
Powered by Fission
Content Management System
|
Website Design
by 360 PSG
Please ensure Javascript is enabled for purposes of
website accessibility