Guest Registration

Guest Registrations

We, at Camp Patriot, first want to thank you for your service to the United States of America. We understand we would not be here if it were not for the service of our brave men and women in uniform. This packet is designed to give us the necessary items to consider you for an adventure with Camp Patriot. We will keep your information secured. To be considered, you must be on active duty and injured or medically retired US Military.

If you are selected, we will be sending you a Camp Patriot letter of invitation and further instructions.

Again, Thank You and God Bless!

* Entry In All Fields Is Required

Personal Information

First Name: *

Middle Name: *

Last Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Email Address: *

Nearest Commercial Airport: *

Service Information

Active Duty: *

Medically Retired: *

Gender: *

Where & When did you serve: *

Branch of Service: *

Rank: *

D.O.B.: *

Specific Injuries Information: *

What is your current level of fitness? Please list any prosthetics you use or special assistance you may require for us to best meet your needs: *

Civilian History: *

Please include any specific adventure that would most interest you: *

Documentation Needed

Please send or email the following documents to accompany this application:

1. DD214

2. Award Letter stating exact disabilities.

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a guest, any false statements, ommisions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Digital Signature: *

Date (00/00/0000): *

To submit form please click "Send Inquiry"