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If you prefer to speak to someone about the Great Gluten Escape Camp,
use the Contact page.

Effective May 2, 2008, the Great Gluten Escape Camp electronic registration has been closed. We have limited space available based on age and/or gender limitations. We will place campers on a waiting list with a fully paid camp deposit of $100. This deposit is non-refundable if the camper is placed. For campers not placed the deposit will be refunded. We expect to complete all waiting list selections by May 20th, 2008, however we will continue to offer placement to campers on the waiting list in the event we have cancellations after May 20th, 2008.

It is our policy to return all registrations that are not complete, that do not have the complete deposit, or that have contingencies. For more information please contact the camp registrar via email or 972-727-4654.

Late Registration/Partial Payments: Effective May 2, 2008 the camp fee will increase to $425 and full payment will be required at the time of placement from the waiting list. Any paid camp deposit will be applied to the late registration fee. If written cancellation notice is received by May 15, 2008, any camp fees paid will be refunded (not including the non-refundable deposit of $100).

Additionally, any remaining balances not paid in full by May 1, 2008 will be subject to a late fee of $30. To make a partial payment click here


Registration Date:
 
 (Ex.MM/DD/YYYY)
Camper Information
Last Name:
 
First Name:
 
Middle Name:
Preferred Name:
 
Address:
 
City:
 
State:
 
 (Please choose state)
Zip Code:
 
Phone:
 
 
(Ex. 999-999-9999)
Age:
Gender:
Date of Birth:
 
 (Ex.MM/DD/YYYY)
School Grade (use current year):
Payment Method:
 
Payment may be sent to:
Great Gluten Escape Camp
1019 Rockefeller Lane
Allen TX 75002

Dietary Restrictions:

DF Note: The camp will serve gluten-free food and accommodate dairy free diets as needed.  All dairy free campers will be required to stay dairy free during camp. For other food restrictions, contact the Camp Nurse BEFORE you register. 

Camp Nurse: Cheryl Gainer, RN ggenurse@dallasrock.org or
(214) 274-6094.

*
*
- see note about DF

*Leave this box un-checked if the camper is not diagnosed (by a licensed physician) with celiac disease/gluten intolerance. This information is collected specifically for grant writing purposes. The camper does not have to be a diagnosed celiac to attend camp.
T-shirt Size:
Ethnicity (optional)
Camper is under the custodial care of:
Mother or Guardian Information
Name:
Address:
City:
State & ZIP:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Father or Other Guardian Information
Name:
Address:
City:
State & ZIP:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Camp Referral
How did you hear about our camp?
Camper Health History
Check all that apply:







Is an EpiPen required?
Chronic/Recurring Conditions
Check all that apply:













Other Conditions?
Allowable Medicines
Check all that apply:






Other Information  
Check all that apply:


Other Special Devices?
Comments, questions or observations?

You may also use this area for accommodation or other special requirements, including other food intolerance.
 

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