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Camp Koru Application
Contact Information








Surf: Participants are housed with 3-4 roommates in cabins. Snow: Participants are housed with 2-3 roommates in bedrooms.


Check all that apply.






 

If you live in Canada (especially Alberta or Quebec), this form may not be able to accept the address. Please use our address: 216 Cascade Ave., Hood River, OR 97031, and include your real address at the bottom of the application.






 
Emergency Contact Information





 
Please tell us about your cancer and medical history



 
Treating Oncologist





Where does your oncologist practice? Example: OHSU, MD Anderson, Dana Farber, etc.

 
Current Physician (PCP) or Oncologist





Which Camp do you want to attend?
Currently we have a waitlist for our camps and are doing our best to get you there as soon as we can! We are hoping to add more opportunities for applicants to attend in 2020, so please check out our website for up to date information! If you have questions, please email: programs@projectkoru.org.




We expect most to select "None" here, but if you have prior experience, please let us know.

We expect most to select "None" here, but if you have prior experience, please let us know.

We expect most to select "None" here, but if you have prior experience, please let us know.

Mountain biking, yoga, kayaking, hiking, running, etc., or none

Help us get to know you!


Share as much or as little as you would like, from detailed info about your diagnosis, to how cancer has affected your life.

This could be your last day of treatment, first day of remission, a surgery date, or whatever you consider that special day you'll never forget that signifies moving forward after cancer.

Basically, tell us why you want to go!


please be as specific as possible. example: "gluten free, but things like soy sauce are okay" or "severe peanut allergy", etc.
Historical Camp Experience





Please tell us when you went, 1. which FD program(s) you did (FDi, FD1, FDX), 2. what activity you participated in (surfing, kayaking, rock climbing, etc.), 3. Location (Hood River, Moab, North Carolina, etc.), and 4. Date (ideally, month and year)


Please tell us when you attended Survive & Thrive, and which program you attended (Grand Canyon, Owyhee River, Sailing, etc)

Please tell us when you attended a Send-It program and which activities you participated in (surfing, skiing/snowboarding, etc)

Please tell us which Camp Mak-A-Dream you attended (Heads Up Conference, Young Adult Camp, etc), and when.

Please share any other camp or retreat you attended specifically for young adults with cancer.


Please be as specific as possible. Now that you've been to one camp/retreat, do you hope to get anything new out of the Camp Koru experience?