Veterans Camp Application Form Please check only one camp for this application; and enter only one family per application form, please. Required fields are noted by * Select a Camp Family Veterans Camp Friday, August 25 – Monday, August 28, 2023 at the KIEVE CAMPUS in Nobleboro Veteran's Name Title: First Name: Last Name: DOB Month: January February March April May June July August September October November December DOB Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 DOB Year: 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 Gender Male Female Additional Family Members Attending Name: Age: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Relationship: Spouse Significant Other Child Mother Father Niece Nephew Other Name: Age: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Relationship: Spouse Significant Other Child Mother Father Niece Nephew Other Name: Age: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Relationship: Spouse Significant Other Child Mother Father Niece Nephew Other Name: Age: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Relationship: Spouse Significant Other Child Mother Father Niece Nephew Other Military Branch and Unit(s) Deployed With Branch: Air Force Army Coast Guard Marine Corps Navy Description (Division, Fleet, MEF, NAF, District): Rank: Number of Deployments: Conflicts Served: Home Address Street: City: State: Zip: Phone: Phone Type: Cell Phone Home Phone Email: Additional Information Please list any allergies we need to be aware of: Food Medicine The environment (insect stings, hay fever, etc.) Other Do you use an EPI PEN (If yes please bring it with you) Allergy details: Describe previous reactions: Disability Rating (if any): Do you require ADA compliant lodging? Any Medical conditions we should be aware of: In case of a medical emergency, whom may we contact? Name: Relationship: Spouse Significant Other Child Brother Sister Mother Father Niece Nephew Friend Other Best Number to contact: Upon acceptance to any of our veterans programs you will be required to send a copy of your DD214 or military ID if you are still active. By sending in this application, I hereby accept and abide by the provisions of the following statement: I understand that all participants in the program or event do so at their own risk and assume all risk related to their participation. I understand that participation in camp activities, can expose us to dangers both from known and unanticipated risks and that exposure to such risks can result in personal injury, including death, or property damage or loss. Acknowledging that such risks exist and that I or my family may be exposed to such risks as part of our participation in any activities at Kieve-Wavus Education, I hereby acknowledge and assume that risk and release and discharge Kieve-Wavus Education, Inc., its officers, agents, and employees from any and all claims or liability for personal injury, including death, or property damage or loss that I/we may suffer while participating in camp activities, including, but not limited to, any claim arising out of the condition of any premises at which the activity is held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity whether planned or unplanned. Submit Your Application Look for your emailed confirmation receipt. If you do not receive it, and it wasn’t in your spam folder, please call us at (207) 549-5719.