Skip to content
  • call us: 832.632.1221
  • Contact Us
  • Blog
  • call us: 832.632.1221
Anchorpoint.usAnchorpoint.us
  • Home
  • Why AP?
  • HOPE
    • Give Hope
    • Be Hope
    • Get Hope
  • Events
    • Run For Health
    • Pathway to Hope Camp
    • BUNCO Night
    • Celebrating Hope Gala 2025
  • Sponsors
  • Volunteer
  • Join 911 Prayer Team
  • GIVE NOW
  • 0
    Cart

    No products in the cart.

  • GIVE NOW

Family Camp Application

Will your target child be between the ages of 5-13 on July 1, 2025?
Will your target child have been living within your home for one year?
Are you and your family willing to be photographed and videotaped?
Are both parents willing to complete a criminal background check?

Parent's Information

Mother's Name(Required)
Address(Required)
MM slash DD slash YYYY
Travel

Father's Name(Required)
Address(Required)
MM slash DD slash YYYY
Travel

Child Information

Please enter a number from 1 to 6.
Target Child Information(Required)
MM slash DD slash YYYY

Sibling Information

Sibling 1(Required)
MM slash DD slash YYYY

Sibling 2(Required)
MM slash DD slash YYYY
Sibling 2 Date of Birth
Sibling 2 Tshirt Size
Sibling 2 Food Allergies

Sibling 3(Required)
MM slash DD slash YYYY
Sibling 3 Date of Birth
Sibling 3 Tshirt Size
Sibling 3 Food Allergies

Sibling 4(Required)
MM slash DD slash YYYY
Sibling 4 Date of Birth
Sibling 4 Tshirt Size
Sibling 4 Food Allergies

Sibling 5(Required)
MM slash DD slash YYYY
Sibling 4 Date of Birth
Sibling 5 Tshirt Size
Sibling 5 Food Allergies

I confirm that the above details are correct and complete(Required)

Other Details

Proceed to the next step(Required)

CHILD PROFILE (Complete for each child)

Name
Is this child adopted?

Previous Care (if applicable)

Category 1
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Stay
Duration of Stay
 
Category 2
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Stay
Duration of Stay
 
Category 3
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Stay
Duration of Stay
 

Has this child experienced:

A difficult pregnancy
A difficult birth
Early hospitalization
Neglect
Physical Abuse
Sexual Abuse
Loss of a Primary Caregiver
Other Trauma

Child Medical History:

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problems?

Medical Diagnoses

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another diagnoses?(Required)
Diagnosis 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another restrictions?(Required)
Restriction 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Physical Limitations

Difficulty 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another limitations?(Required)
Difficulty 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Psychological Diagnosis

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add Phsychological Diagnosis?(Required)
Diagnosis 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Duration of Stay
Comments
 
Injury 2
Cause
Date of Injury
Duration of Stay
Comments
 
Would you like to add Injury(Required)
Injury 3
Cause
Date of Injury
Duration of Stay
Comments
 
Injury 4
Cause
Date of Injury
Duration of Stay
Comments
 

Serious Illness

Illness 1
Illness
Date of Onset
Duration of Stay
Comments
 
Illness 2
Illness
Date of Onset
Duration of Stay
Comments
 
Would you like to add another illness?(Required)
Illness 3
Illness
Date of Onset
Duration of Stay
Comments
 
Illness 4
Illness
Date of Onset
Duration of Stay
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Reason
Date of Entry
Duration of Stay
Comments
 
Hospitalization 2
Reason
Date of Entry
Duration of Stay
Comments
 
Would you like to add another hospitalization?(Required)
Hospitalization 3
Reason
Date of Entry
Duration of Stay
Comments
 
Hospitalization 4
Reason
Date of Entry
Duration of Stay
Comments
 

Concerns:

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have educational difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Are any other children residing in the home? YES NO(Required)
** if yes, please complete child profile for each child in family.

CHILD PROFILE

Name
Is this child adopted?

Previous Care (if applicable)

Care Environment 1
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 
Care Environment 2
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 
Care Environment 3
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 

Has this child experienced:

A difficult pregnancy
A difficult birth
Early hospitalization
Neglect
Physical Abuse
Sexual Abuse
Loss of a Primary Caregiver
Other Trauma

Child Medical History:

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problems?

Medical Diagnoses

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another diagnosis?(Required)
Diagnosis 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another restrictions?(Required)
Restriction 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Physical Limitations

Difficulty 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another physical limitations?(Required)
Difficulty 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Psychological Diagnosis

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Would you like to add another psychological diagnosis?(Required)
Diagnosis 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 4
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Duration of Stay
Comments
 
Injury 2
Cause
Date of Injury
Duration of Stay
Comments
 
Would you like to add another physical injury?(Required)
Injury 3
Cause
Date of Injury
Duration of Stay
Comments
 
Injury 4
Cause
Date of Injury
Duration of Stay
Comments
 

Serious Illness

Illness 1
Illness
Date of Onset
Duration of Stay
Comments
 
Illness 2
Illness
Date of Onset
Duration of Stay
Comments
 
Would you like to add another serious illness?(Required)
Illness 3
Illness
Date of Onset
Duration of Stay
Comments
 
Illness 4
Illness
Date of Onset
Duration of Stay
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Reason
Date of Entry
Duration of Stay
Comments
 
Hospitalization 2
Reason
Date of Entry
Duration of Stay
Comments
 
Would you like to add another hospitalization?(Required)
Hospitalization 3
Reason
Date of Entry
Duration of Stay
Comments
 
Hospitalization 4
Reason
Date of Entry
Duration of Stay
Comments
 

Concerns:

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have educational difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Do you want to add another Child Profile(Required)

Child Profile

Name
Is this child adopted?

Previous Care

Care Environment 1
Type of Care
Age of Entry
Duration of Stay
 
Care Environment 2
Type of Care
Age of Entry
Duration of Stay
 
Care Environment 3
Type of Care
Age of Entry
Duration of Stay
 
Care Environment 4
Type of Care
Age of Entry
Duration of Stay
 

Has this child experience:

A difficult pregnancy
A difficult birth
Early hospitalization
Neglect
Physical Abuse
Sexual Abuse
Loss of primary caregiver
Other Trauma

Child Medical History

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Does the child have any medical or physical diagnoses?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problems?

Medical Diagnosis

Diagnosis 1
Label
Date of Diagnosis
Current Medication (If any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medication (If any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medication (If any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medication (If any)
Comments
 
Restriction 3
Label
Date of Diagnosis
Current Medication (If any)
Comments
 

Physical Limitations

Diagnosis 1
Label
Date of Diagnosis
Current Medication (If any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medication (If any)
Comments
 
Diagnosis 3
Label
Date of Diagnosis
Current Medication (If any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Current Medication (If any)
Comments
 
Injury 2
Cause
Date of Injury
Current Medication (If any)
Comments
 
Injury 3
Cause
Date of Injury
Current Medication (If any)
Comments
 

Serious Illnesses

Illness 1
Illness
Date of Onset
Current Medication (If any)
Comments
 
Illness 2
Illness
Date of Onset
Current Medication (If any)
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Illness
Date of Onset
Current Medication (If any)
Comments
 
Hospitalization 2
Illness
Date of Onset
Current Medication (If any)
Comments
 
Hospitalization 3
Illness
Date of Onset
Current Medication (If any)
Comments
 

Concerns

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have educational difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Add another child profile?(Required)

Child Profile

Name
Is this child adopted?

Previous Care (if applicable)

Care Environment 1
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 
Care Environment 2
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 
Care Environment 3
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age at Entry
Duration of Stay
 

Has this child experienced:

A difficult pregnancy
A difficult birth
Early hospitalization
Neglect
Physical Abuse
Sexual Abuse
Loss of a Primary Caregiver
Other Trauma

Child Medical History:

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problems?

Medical Diagnoses

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Physical Limitations

Difficulty 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Date of Stay
Comments
 
Injury 2
Cause
Date of Injury
Date of Stay
Comments
 

Serious Illness

Illness 2
Inllness
Date of Onset
Date of Stay
Comments
 
Illness 1
Illness
Date of Onset
Date of Stay
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Reason
Date of Entry
Date of Stay
Comments
 
Hospitalization 2
Reason
Date of Entry
Date of Stay
Comments
 

Concerns:

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have educational difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Do you like to add another child profile?(Required)

Child Profile

Name
Is this child adopted?

Previous care (If applicable)

Care Environment 1
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 
Care Environment 2
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 
Care Environment 3
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 

Has this child experienced:

A difficult pregnancy
A difficult birth
Early hospitalization
Neglect
Physical Abuse
Sexual Abuse
Loss of a Primary Caregiver
Other Trauma

Child Medical History

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problem?

Medical Diagnoses

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Physical Limitations

Difficulty 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Psychological Diagnosis

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Current Medications (if any)
Comments
 
Injury 2
Cause
Date of Injury
Current Medications (if any)
Comments
 

Serious Illness

Illness 1
Illness
Date of Onset
Current Medications (if any)
Comments
 
Illness 2
Illness
Date of Onset
Current Medications (if any)
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Reason
Date of Entry
Current Medications (if any)
Comments
 
Hospitalization 2
Reason
Date of Entry
Current Medications (if any)
Comments
 

Concerns:

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Do you want to add another child profile?(Required)

Child Profile

Name
Is this child adopted?

Previous Care (if applicable)

Care Environment 1
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 
Care Environment 2
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 
Care Environment 3
Type of Care (i.e., foster care, orphanage, group home, only our home, etc.)
Age of Entry
Duration of Stay
 

Child Medical History:

Does the child have any medical or physical diagnoses?
Does the child have any known allergies or food restrictions?
Does this child have any limiting physical difficulties?
Has this child received any psychological diagnoses (e.g., ADD/ADHD, Autism, ODD, etc.)?
Has this child ever been hospitalized for a serious injury (e.g., broken bones, head trauma, bleeding)?
Has this child ever been hospitalized for a significant illness (e.g., pneumonia, asthma, etc)?
Has this child ever been hospitalized for behavioral or emotional problem?

Medical Diagnoses

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Allergies or Food Restrictions

Restriction 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Restriction 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Physical Limitations

Difficulty 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Difficulty 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Psychological Diagnosis

Diagnosis 1
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 2
Label
Date of Diagnosis
Current Medications (if any)
Comments
 
Diagnosis 3
Label
Date of Diagnosis
Current Medications (if any)
Comments
 

Serious Injuries

Injury 1
Cause
Date of Injury
Duration of Stay
Comments
 
Injury 2
Cause
Date of Injury
Duration of Stay
Comments
 

Serious Illness

Illness 1
illness
Date of Onset
Duration of Stay
Comments
 
Illness 2
illness
Date of Onset
Duration of Stay
Comments
 

Behavioral or Emotional Problems

Hospitalization 1
Reason
Date of Entry
Duration of Stay
Comments
 
Hospitalization 2
Reason
Date of Entry
Duration of Stay
Comments
 

Concerns

Does the child have behavioral difficulties?
Does the child have emotional difficulties?
Does this child have educational difficulties?
Does this child have sensory difficulties?
Does this child have social difficulties?
Have you ever worried about the physical safety of your child or others around your child because of the emotional or behavioral difficulties your child may be experiencing?
Has your child ever harmed or attempted to harm another person, animal or himself?

Contact Us

Address:
103 Davis Road, Suite B
League City, TX 77573

Office:                      Email:
832-632-1221      info@anchorpoint.us

Recent Posts
  • 02
    Oct
    Parenting Doesn’t Come with a Manual No Comments on Parenting Doesn’t Come with a Manual
  • 24
    Sep
    Faith-Filled Discipline: Guiding Hearts, Not Just Behaviors No Comments on Faith-Filled Discipline: Guiding Hearts, Not Just Behaviors
  • 19
    Sep
    Teaching Kids to Pray: Simple Ways to Start at Any Age Comments Off on Teaching Kids to Pray: Simple Ways to Start at Any Age
Quick Links

Privacy Policy
Terms and Conditions
Volunteer Policy and Code of Conduct

Visa
PayPal
Stripe
MasterCard
Cash On Delivery
Copyright 2025 © Anchor Point
  • Home
  • Why AP?
  • HOPE
    • Give Hope
    • Be Hope
    • Get Hope
  • Events
    • Run For Health
    • Pathway to Hope Camp
    • BUNCO Night
    • Celebrating Hope Gala 2025
  • Sponsors
  • Volunteer
  • Join 911 Prayer Team
  • Login
  • Newsletter
  • GIVE NOW
X