Apply – Camp BullWheel

*First Name	*Last Name	*Phone
*Email	Address	PO Box
City	State	Zip
Preferred dates you would like to come
Whom would you like to have come along? Number and Names of Companions Ages Dietary Restrictions for you or your companions?
Please tell us about your disability, experience and expectations:
How it affects your daily activities and ability to walk, lift, maneuver, etc. Describe mobility device used (manual wheelchair, power wheelchair, walker, cane, etc.) Types of adaptive equip/assistive tech you use regularly, how used, and your accomplishments. Describe types of adaptive equip/assistive tech that might help you be fully functional at CB Your experience fishing and with water sports. Needs and/or expectations for lodging at the Camp outside of fishing? Any individual requests and/or info you want to share not covered above? Do you have a Service Dog? Breed and Disposition