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352-502-0379

Never Say Never Foundation

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Home
Pirate Camp
Amp Camp
Sponsors
The Foundation
News
Contact Us
Donate

Amp Camp Application

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Amp Camp Application

Sign Up For Amp Camp Online

There are a few important steps to completing an online application for Amp Camp.

Please complete the online form below and click submit.
Important: You must download, sign and mail the waiver found at this link or your application is NOT complete. Again, if we do not receive your completed waiver in the mail, your application is NOT complete and your camper will not be accepted.
Don’t forget to mail the completed waiver forms to:
Never Say Never Foundation
3965 NE 15th Court Rd
Ocala, FL 34479

Your child’s application will be considered incomplete until the receipt of the completed waiver forms, which must arrive via snail mail by January 31, 2024.

If you experience any issues with the form below or any part of the online application process, please remember you can still apply by downloading, completing, and mailing all of the forms available on this page.

"*" indicates required fields

Applicant (Camper) Information

Child's Name*

First Last

Child's Gender*

Female

Male

Date Of Birth*

MM slash DD slash YYYY

Child's Age

Child's T-Shirt Size*

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Adult 3XL

Address*

Street Address City State ZIP Code

Level(s) Of Limb Difference*

Please indicate your child's level(s) of limb difference.

Left Lower Extremity AK

Left Lower Extremity BK

Left Upper Extremity AE

Left Upper Extremity BE

Right Lower Extremity AK

Right Lower Extremity BK

Right Upper Extremity AE

Right Upper Extremity BE

Does the camper have a prosthetic limb?*

Yes

No

If the camper has a prosthesis, is it waterproof?*

Yes

No

Does the camper have swimming experience?*

Yes

No

Does the camper have any water limitations?*

Yes

No

Does the camper have any special needs or conditions?*

Yes

No

Does the camper have any allergies to food or medication?*

Yes

No

Does the camper have any dietary restrictions?*

Yes

No

Does the camper take any medications we should be aware of?*

Yes

No

Does the camper have a running blade?*

Yes

No

If you answered "yes" to any questions above, please elaborate.

If you answered yes, to any of the above questions that requires elaboration, or feel there is information we should know about your child, please provide details below:

Camper's Medical Conditions, Allergies, Dietary Needs & Accomodations*

Please list any medical conditions, allergies, special dietary needs, accommodation requirements (ie. wheelchair accessible bathroom) or general concerns that should be made known for any of the camp participants:

Parent/Guardian Information

We will be using the email provided below as the main point of contact for all Pirate Camp news and updates.

Parent/Guardian Name*

First Last

Parent/Guardian Phone*

Parent/Guardian Email*

Emergency Contact Information

Please double-check the information you provide for accuracy.

Emergency Contact Name*

First Last

Emergency Contact Phone*

Camper's Guests

Please list all family members attending the event with Camper. Please include ALL family members, including Parent/Guardian.

Guest 1 Name

Guest 1 DOB

MM slash DD slash YYYY

Guest 1 Age

Guest 1 Shirt Size

Guest 2 Name

Guest 2 DOB

MM slash DD slash YYYY

Guest 2 Age

Guest 2 Shirt Size

Guest 3 Name

Guest 3 DOB

MM slash DD slash YYYY

Guest 3 Age

Guest 3 Shirt Size

Guest 4 Name

Guest 4 DOB

MM slash DD slash YYYY

Guest 4 Age

Guest 4 Shirt Size

Guest 5 Name

Guest 5 DOB

MM slash DD slash YYYY

Guest 5 Age

Guest 5 Shirt Size

Important Information To Keep In Mind

The Never Say Never Foundation does not provide transportation to or from Amp Camp (this includes air fare). The nearest major airports are in Orlando (MCO) and Tampa (TPA). You are responsible for getting to Camp Kiwanis in Silver Springs, FL. Meals and lodging are provided for Wednesday evening through Sunday breakfast. Please let DeRuse [email protected] know if you have any questions/comments/concerns.

Our vision is to help children and young adults with challenges in their lives to overcome adversity with a positive attitude and to understand that you can do anything you want if you put your mind to it. You are the only person who can limit you- never say never!

Contact Us

Never Say Never Foundation
3965 NE 15th Court Road
Ocala, FL 34479

Phone: 352.502.0379
Fax: 352.368.7079

Website Maintained by: ClickFirst Marketing

Find us on:

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News

Sprinter Nick Rogers Enjoys Giving Back To Same Organizations That Helped Him
April 5, 2021
University Of Florida Talks With Never Say Never Foundation Co-founder Nick Stilwell
March 22, 2021
Never Say Never Featured In Golf Central Magazine
February 25, 2020

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