Campfire Circle

New Family Enrollment for Campfire Circle

If you have already received a username and password for your family, you do not need to fill this form out. Please click here to log in to your Family Account.

If you are new to Campfire Circle, or you are a Camp Oki or Camp Jumoke camper, and you do not have a Family Account, please submit this form for your child(ren) and family. Our Medical Team will review your form and follow up within 5 business days.

Please include all members of your family that might attend any of the programs

+Add another camper... add additional siblings

+Add second parent... add additional parent/guardian

* are mandatory fields

Family questions

Which language would you prefer to speak to our staff in?

Campfire Circle has access to Interpreter Services. Would you like to use an interpreter to communicate with Camp staff? This service is free for you.

Camper information

First name

Last name

Gender

Date of birth

Additional questions

Please indicate which category your child belongs to.

Please answer the following questions if this child is currently on or off treatment.

Diagnosis:

Diagnosis Type:

Division:

Date of Diagnosis

If your child is off treatment, when was their last treatment?

Name of Primary Physician (i.e. Oncologist, Hematologist, Cardiologist, etc.)

Primary Treatment Centre

If other Primary Treatment Centre, please specify:

In order to better understand the community we serve and to provide access to diverse, equitable, and inclusive programming, Camp is asking about campers' backgrounds. We recognize that many people have multiple identities. Please select the identity below that best describes you.

If there is an additional identity that describes you, please select another below.

* are mandatory fields

Cell phone

Add another camper...

Additional information

How did you hear about us?

Who did you hear about us from?

Home address

International Address

Address

Apt, Suite, Bldg.

City

Zip

State

Region

Country

Home phone

Parent 1 information

First name

Last name

E-mail address

Password

Confirm password

Relationship

Cell phone

Opt in to text message notifications

Work phone

+ Add second parent...

Parent 2 information

Remove this parent

First name

Last name

E-mail address

Relationship

Cell phone

Opt in to text message notifications

Work phone

Please confirm that you're not a robot: