Camp Crossroads Application Home/Camp Crossroads ApplicationCamp Crossroads Application 2022* Indicates required field.Name of Applicant: * RequiredDOB (MM/DD/YEAR): * RequiredGender * RequiredGender *MaleFemalePrefer to Self-DescribeSelf-Describe:Address: * RequiredApartment/Unit # * RequiredCity: * RequiredState: * RequiredZip Code: * RequiredParent/Guardian Name: * RequiredRelationship: * RequiredPhone Number: * RequiredEmail Address: * RequiredContact Preference * RequiredContact Preference *PhoneEmailDoes your child understand what Substance Use Disorder is? If yes, briefly describe the impact: * RequiredConnection to St. Luke's Penn Foundation (if any): * RequiredComments or Concerns * RequiredCAPTCHAΔ