No

n-P

rofit O

rg.

US

Posta

ge

PA

ID

Perm

it 19

66

S

alt Lak

e City

, UT

KD

F/C

amp

Kostop

ulos

4180

E E

migration

Can

yon

Salt Lak

e City, U

T 84

108

**Please number boxes by preference, #1 start-ing as 1st choice. If you would like to attend more than one week please indicate below by checking the box & indicate in the blank how

many weeks you would like to attend.

I would like to request to attend_______ of the marked weeks below.

Residential Camp Dates

Kickoff Week , May 31-June 3 (4 days) - Adults

*Limited Availability* $100 deposit due at registration

$400 if paid in full by March 15th $425 if paid after March 15th

Week 1, June 6-10— Adults

Week 2, June 13-17 — Teens

Week 3, June 20-24 — Kids & Teens

Week 4, June 27-July 1 — Adults

Week 5, July 4-8 — Teens

Week 6, July 11-15 — Kids & Teens

Week 7, July 18-22—Horse Camp: Adults & Teens

Week 8, July 25-29—Horse Camp: Kids & Teens

Registrations are processed in the order received. If the week

you request is full, we will contact you. Additional paperwork

will be mailed after registration is completed.

Residential Camp Cost

The actual cost for one camper to attend a week of camp is $1,100.00. Your help is appreciated in

paying the minimum of $525.00, and any additional amount toward the $1,100.00.

Please send payment & registration to: Kostopulos Dream Foundation

4180 Emigration Canyon Rd. Salt Lake City, UT 84108

www.campk.org (801) 582-0700

Fax (801) 583-5176

Home of Camp K!

Summer Camp 2016 “Opening a World of

Opportunities for People of all Abilities”

Residential Summer Camp Come join Camp K in making unforgettable memories! Our goal is to provide a

summer camp that promotes a healthy recreation and therapeutic leisure lifestyle for individuals with physical and cogni-

tive disabilities.

Connecting with people who share similar circumstances is beneficial and helps

increase self efficacy. Camp K is proud to have 2 specialty programs; one for

individuals with Neurofibromatosis (NF) and one for individuals who have had organ transplants. These two specialty

programs are one of a kind and attract participants from all over the country!

The five-day, four-night residential camp begins Monday morning and ends Friday at noon. Campers stay in bunk-style

cabins with restrooms and have 24-hour supervision by our trained staff. Campers have the opportunity to participate in

arts/crafts, canoeing, nature, horseback riding, low/high ropes course, climbing wall, swimming, fishing, etc.

* A 50 dollar fee will be added for any camper not picked up 30 minutes past the pick up time.

Residential Horse Camp For the first time in the History of Camp K we will be offering a 1 week residential horse camp. This camp is designed to enhance the riding and horse care and management skills of individuals who already have basic riding skills. Campers will also be able to take advantage of Camp K’s other amenities including swimming, fishing, and low ropes course. This camp is for individuals ages 8 – 21. *Preapproval is required.

Travel Trip Adventures See the enclosed flyer for details about the 10 exciting trips we have planned this summer. Prior approval is required to

attend trip camps. Interested campers will be contacted by program coordinators after receiving trip camp registration.

Campers need to be able to work on a strict 4:1 camper to staff ratio, be able to take care of their own personal care needs,

and have no current tendency of wandering/running, or aggression to self or others.

*All money received is non-refundable* *Should DSPD not cover the program you are still responsible to cover the cost of the program*

*For special diets participants are required to bring their own food* *Camp Kostopulos is accredited by the American Camping Association, an agency that sets standards and reviews camp operations across the U.S.*

*IMPORTANT INFORMATION—PLEASE READ* Sign up early! Camp reservations are on a first-come, first-serve basis. The supervision ratio is one counselor for every four

campers. If your camper needs a higher level of supervision, prior approval must be given and every

effort will be made to accommodate him/her. Contact Tiffanee or Emily for approval of special arrangements. Nurses are on-

site during the day and evening and on-call at night. Financial aid/scholarships are available to those who qualify. If

awarded the scholarship it will only be applied to 1 week. All campers must be free from illnesses at time of check in. Due to

county safety standards all campers that have a history of incontinence or a recent sickness must wear swim diapers in the

pool. These can be purchased at local medical supply stores or at Camp K for a nominal fee. Campers may be sent home at

any time for illness or aggression towards other campers or staff. If you have any questions please contact Tiffanee Rogers

Residential Summer Camp Come join Camp K in making unforgettable memories! Our goal is to provide a

summer camp that promotes a healthy lifestyle for individuals with physical and

cognitive disabilities, utilizing education and therapeutic recreation.

Connecting with people who share similar circumstances is beneficial and helps

increase self-efficacy. The five-day, four-night residential camp begins Monday

morning, and ends Friday. Campers stay in bunk-style cabins with restrooms, and have 24-hour supervision by our

trained staff. Each participant will have the opportunity to participate in arts and crafts, canoeing, nature, horseback

riding, low/high ropes course, climbing wall, swimming, fishing, and much more.

Horse Camp

Camp Kostopulos is holding two horse camps at the end of July! The horse camps are structured like the residential

camps, with five-day, four-night residential camps beginning Monday morning, and ending

Friday. Campers stay in bunk-style cabins with restrooms, and have 24-hour supervision by our

trained staff. Campers will have the opportunity to spend time in the equestrian center where

they will learn how to groom and care for the horses, and spend time feeding and riding them.

**Drop off is between 8 am-10 am Monday morning. Please keep in mind this is the first day of camp and could

take up to one hour to properly check in. All Parents/Guardians MUST stay with camper until full check in

process is completed. Pick-up time is 11:30 am on Friday (Awards ceremony for campers at 11:00 am). A $50 fee will be added if camper is

not picked up within 30 minutes of pick-up time.**

*IMPORTANT INFORMATION — PLEASE READ* Sign up early! Camp reservations are on a first-come, first-served basis. All new campers and parents must be assessed

prior to acceptance into our program. The supervision ratio is one counselor for every four campers. If your camper

needs a higher level of supervision, prior approval must be given, and every effort will be made to accommodate him/

her. Contact one of our Program Staff, Jamie or Kristy, for approval or special arrangements. Nurses are on-site during

the day and evening, and on-call at night. Financial aid/scholarships are available to those who qualify. If awarded the

scholarship, it will only be applied to 1 week. All campers must be free from illnesses at time of check in. Any camper

with a history of seizures must wear a life jacket during all water activities. Due to county safety standards, all campers

who have a history of incontinence or a recent sickness must wear swim diapers in the pool. Camp K will not provide

these, but they may be purchased at any medical supply store, and some drug stores. Campers may be sent home at any

time for illness or behavior issues towards other campers or staff. If you have any questions, please contact Jamie

Blaisdell, TRS/CTRS, or Kristy King, TRS/CTRS, at 801-582-0700 ext. 100 or 109.

*All money received is non-refundable*

*Should DSPD deny payment, you are responsible to pay the cost of the program*

*For special diets, participants are required to bring their own food*

*Camp Kostopulos is accredited by the American Camp Association, an agency that sets standards and reviews camp operations

across the U.S.*

Residential Registration Form 2016

Camper Name: ______________________________________

Parent/Guardian: ____________________________________

DOB: ____/____/____ Gender: M F

Address: ___________________________________________

City: ________________ St: ____ Zip: __________

Day Phone: (______)__________________________

Evening Phone: (______)_______________________

Email: ______________________________________

Has camper attended Camp K Summer Camp in the past? Y N

T-Shirt size: Child: SM MED LG XL

Adult: SM MED LG XL 2XL 3XL

*** By completing this registration form, you agree that if the

camper is sent home for endangering the safety of themselves, staff

or campers, there is no refund of the camp fee.***

COST

Full payment received by March 15, 2016: $500.00

Full payment received after March 15, 2016: $525.00

*Mandatory Deposit $100.00 each week due with registration.*

*Deposit is non-refundable in case of cancellation.*

*Balance due one week prior to camp week*

PAYMENT METHOD

Check - Amount Enclosed: $____________

DSPD Funds (Do not send $100 deposit)

Caseworker: ___________________________

Phone #: ______________________________

Credit Card - Amount to charge: $____________

I would like to apply for financial assistance. Enclosed

is the $100 minimum required deposit.

OFFICE USE ONLY

Amount Received:$________________

Date Received:_______/_______/_______

Check#: ____________

Card#

Exp Date Zip Code

Signature