Additional Behavioral Support Form
THIS FORM MUST BE SUBMITTED AS PART OF THE APPLICATION IF: Applicant has a behavioral, emotional ,or mental health diagnosis (e.g., ADD/ADHD, Anxiety, Depression, OCD), has seen a mental health professional (e.g., social worker, psychologist, psychiatrist) in the past 12 months, has been prescribed or is currently taking a mood-altering medication for any reason AND additional information has been requested by JA Camp mental health director. THIS FORM MUST BE COMPLETED BY: (1)The mental health professional (social worker, psychologist, psychiatrist, etc.)currently overseeing the applicant’s care, if applicable, OR; (2)The medical professional that prescribed the medication or diagnosed the behavioral, emotional, or mental health condition.

Additional Medical Diagnosis
THIS FORM MUST BE SUBMITTED AS PART OF THE APPLICATION IF: Applicant has a diagnosis in addition to their childhood rheumatic disease diagnosis AND additional information has been requested by JA Camp medical director. THIS FORM MUST BE SUBMITTED ALL APPLICANTS AND COMPLETED BY: (1)The medical professional that manages additional diagnosis.

Reference Form
Please input the contact information for a professional, academic, or personal reference that can speak to your abilities as a potential JA Camp Volutneer.