Beyond Akeela Application: Camper Questionnaire

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Your Name:      
Your Birthdate: 
Parent Name:    

In the space below, please share with us any thoughts or feelings you have about coming to Beyond Akeela this summer.

Please tell us three things you are looking forward to at Beyond Akeela:
1.
2.
3.

Please tell us three things you are NOT looking forward to at Beyond Akeela:
1.
2.
3.

What makes you act:

1. Happy          
2. Angry          
3. Scared/Worried 

What else would you like us to know about you?

Please type the code shown in the image:

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When you're finished, please click this submit button once only.
Thank you!