2024 Camp Wieser Interest Form Hello! Thank you for your interest in applying for Camp Wieser 2024. Camp dates are September 13, 14 and 15, at Mission Springs Conference Center in Scotts Valley, California. This form puts your name in the application queue for Camp Wieser 2024. Please complete and submit this form so we can immediately email you a Physician's Release form to fill out and take to your oncologist or medical provider. A signed Physician's Release form is a necessary step prior to registering for camp.After you click the Submit button at the bottom of this short form, you name will be entered in the application queue. Check your inbox for an email response from a Camper Ambassador with the doctor's form attached. Top priority is given to applicants who are currently receiving cancer-directed treatment and who have not attended Camp Wieser before.Camp fills up fast, so please act soon! Name* First Last Email* Enter Email Confirm Email Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I am aware that travel expenses to attend camp are my responsibility.*Your lodging, meals and activities while at camp are no cost to you. The cost of travel to camp and back home are the responsibility of the patient and their guests. I am aware.If invited to camp, how many family or friends will you ask to come with you?*(You can invite up to four family members, friends or supporters - camp is almost full and the largest rooms available sleep 5 ) Would this be your first time attending a Me-One Foundation Camp?* Yes No Are you 18 years of age or older on September 13, 2024?* Yes No Are you currently receiving active cancer-directed therapy?* Yes No Camp Wieser is free for you and your guests to attend, but are you aware that you need to provide your own transportation to Scotts Valley?* Yes No Everyone coming to Camp will be asked to test for COVID the day prior to arrival. COVID vaccinations and boosters are recommended for everyone but are not required. Are you comfortable with that?* Yes No HiddenPatients at Camp must be able to provide their own self-care. Will you be able to manage your own care while at camp?*A medical team will be available at Camp Wieser for emergencies; however, patients will be responsible for management of all personal and medical care issues while in attendance. Yes No The facilities at Camp Wieser are not fully ADA compliant and if invited, you will encounter some stairs and a lack of air conditioning. Are you comfortable with that?* Yes No I understand that campers must be able to manage their own care at Camp Wieser.* I understand.Patients at Camp must be able to provide their own self-care during the weekend. The medical professionals at camp are there for minor emergencies. HiddenHow did you learn about Camp Wieser? If you were referred by your oncologist or staff, please indicate who referred you.* How did you learn about Camp Wieser? If you were referred by your oncologist or their staff, please indicate who referred you.*Thank you for starting the process of applying for Camp Wieser 2024. Check your inbox for a confirmation email with more information.