Camp Insurance Application [1] Name of Camp * Campus * Boulder Denver Anschutz Medical Campus Colorado Springs Begin Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027 End Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027 Total Number of Days * Expected Number of Participants * Do Campers Spend the Night? * Yes No, they go back to their own homes Number of Employees Working During Camp * 1-5 6-10 11-15 15 or more None Number of Volunteers Working During Camp * 1-5 6-10 11-15 15 or more None Camp Type * Academic Athletic Activity * Location * Department Name * Department Coordinator * Campus Box Number * Mode of Travel * Speed Type Number Approving Org # (Colorado Springs only) Campus Telephone * Campus Fax * Email Address * Additional Comments APPLICATION COPY If you would like a copy of this application, please enter your email address below and a copy will be emailed. Application Copy Email Address CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.