Name *
Date of Birth
Date of Birth
Phone *
Address *
100% of what you submit will remain confidential. We know it can be hard to talk about your abuse, so don't feel obligated to write about your abuse here. Just give us an idea of why you want to come to camp, however if you feel comfortable discussing your abuse know that this is a safe space.
Check all that apply *
We are committed to creating a safe camp environment for all of our campers. Please check the following that apply to your therapy history:
Have you started your menstural cycle? *
If you answered no above, has this been explained to you by an adult?
Required Documents upon Application: *
Check all that you have ready to submit
Emergency Contact
Emergency Contact

Camper Application

We are looking for campers to attend Camp CADI 2019! Camp will be held in King, North Carolina from June 1st - June 7th, 2019. Please fill out the following questioner allowing us to get to know you a little bit better. We will follow up with you to get more detailed information, and we are looking forward to getting to know you!  

100% of the information you provide will remain confidential. 

Click button below for full camper application. Fill out and email to our founder Amy Barth at