Day Camp Application

Asthma Camp - HERC offers free day camps for children ages 6-14 who have been diagnosed with asthma and want to learn more about managing their condition. 

A licensed professional teaches the children asthma management techniques and ways to recognize triggers and symptoms. Other subjects are: asthma action plans, exercise, nutrition, and building self-esteem. Each camp serves approximately 10 children.
Fill out this form and send in, or call the Asthma Department at 401-6810  
   HERC Day Camp
  828 Innes Ave., Suite 110 - or - 2 Cameron Way
    San Francisco, CA  94124
Space is Limited
APPLICATIONS ARE PROCESSED ON A FIRST COME, FIRST SERVED BASIS

All contact information must be filled in

Your First Name:* Initial: Last Name:*
Street Address:* Apt. : Zip Code:*
Home Phone:* Other Phone:    
E-Mail:
Child's First Name: * Initial: Last Name: *
If child's address is different from yours:
Child's Street Address: Apt.: Zip Code:
Special Needs