Welcome to Camp Stewart for Boys. In the Texas Hill Country

Application for CAMP STEWART for BOYS
Hunt, Texas USA 78024
Ph 830/238-4670 Fax 830/238-4737
e-mail the office
Selected One of America's Top Camps

Click here to Download this application for mail or fax

Photo of prospective camper, along with a $500 deposit must accompany this application.

Please select term you wish to attend:

1^st Choice: 2^nd Choice:

Camper's Full Name: Nickname:

Camper's Date of Birth: Age: Height: Weight:

School Currently Attending:

Grade to be completed by camp:

Home Address:

City: State: Zip:

Country: Email:

Mother's name: Profession:

Home Phone: Work Phone: Fax:

Father's name: Profession:

Home Phone: Work Phone: Fax:

Does Camper live with both parents? If not with whom?

To whom should reports go? Is either parent deceased?

Is child affected, or likely to be affected, by any custody orders during camp session?
Yes No

Church Affiliation:

Where did you learn about Camp Stewart? (Be Specific)

Family members who have attended Stewart? Names and approximate years

Other camps previously attended and dates:

Can camper swim?

Play Musical Instrument? Yes No If yes, what?

Names and ages of siblings:

What does camper want to gain most from camp?

What are parental objectives?

Stewart is an active camp; all campers are expected to take part in all activities unless for medical reasons. If there are any activities in which camper should not participate for medical reasons list:

Is there anything the counselor or camp office should know about camper?
(medical, physical, emotional)

Is camper taking or likely to be taking any medications on a regular basis? Yes No

Has camper been on and stopped taking any behavior altering drugs in the last 12 months?

Yes No

I recognize that there are elements of risks in the activities at Camp. I give my permission for the
above named camper to participate in and to be transported to all activities. In the event I can not be
reached in a situation the camp regards as a medical emergency, I hereby give my permission to the camp director to secure proper medical treatment, which may include, but not limited to, hospitalization, surgery, ordering of injection, anesthesia for the person named herein. I have read
or will read, and agree to comply to, all rules and regulations of Camp Stewart. All fees are payable to
Camp Stewart, Hunt, Texas, and for further consideration for allowing my son, or sons, to attend Camp Stewart for the period heretofore designated. I hereby release Si Ragsdale,
individually, Kathy C. Ragsdale, individually, Jeeper Ragsdale, individually, any staff person, consultant or clinician, and Camp Stewart. Inc., from any damages for any personal injury or sickness, or otherwise suffered by my son, or sons, due to any accident on or off Camp Stewart premises that might occur to my son, or sons, while enrolled at Camp Stewart.

Please enter name of Parent Completing this registration:

Please enter name of camper:

Deposit of $500 must accompany application. 80% of Deposit is Refundable upon request by written correspondence until March 1 of year for which applied. Deposits non-refundable after March 1

$500.00 Deposit may be charged to credit card or call (830) 238-4670 or fax (830) 238-4737

Card Type: Account #

Expiration Date CIV #
Name of Card Holder: