Form

Camper Interest Form
Please complete this form and one of our coordinators will be in touch to talk you through the process and criteria

Over The Wall provides free residential activity camps to help children and teenagers living with serious health challenges and their families.

The camper interest form is the first stage of our application process. If you are interested in any of our camps or want to refer a family please complete this form as soon as possible. Completing this form does not commit you in any way. Once submitted your local regional coordinator will be in touch.
Please read the essential requirements to ensure your child is suitable for camp -

Essential Requirements

To ensure your child is able to benefit fully from our camp programme, they must:

Have the physical ability to participate in an action packed activity programme.

Have the social and emotional ability to participate in a group setting with their peers.

Be able to communicate their needs independently.

Be able to transfer independently if they use a wheelchair.

Unfortunatley, we are unable to accept campers who:

Have Cystic Fibrosis or primary ciliary dyskinesia.

Are more than 2-3 years off treatment and do not have any ongoing health challenges.

Have learning, behavioural or social communication needs that would prevent them from participating in age appropriate group activities

Need overnight care/intervention/monitoring, or health care needs that require constant one to one support.
Family Surname *
Has your child attended an OTW camp before? *
If you are associated with one of our partner charities please identify who:
If you select one of our partner charities as above, your contact details will be shared between OTW and the associated partner charity to ensure we are providing the best service possible.
How did you hear about us? *
Please indicate below the names and ages of your children and if they are campers (with or had an illness) or siblings (siblings of child that has or had an illness)

Who would you like to attend camp?

	Full Name	Age	Gender	Camper/Sibling
1
2
3
4
5

Primary diagnosis of child with health challenge: *
Parent/Guardian Details
Full name *

First Name Last Name
Relationship to children *

Address *

Street Address
Street Address Line 2
City	State / Province
Post code	Country

Phone Number *

- Area Code Phone Number
Phone Number

- Area Code Phone Number
E-mail
Referrer Details (if applicable or are referring a family)
Title
Full name

First Name Last Name
Hospital or Organisation
Position
Phone Number

- Area Code Phone Number
Mobile Number

- Area Code Phone Number
E-mail
Thank you, your local regional coordinator will be in contact with you soon.
If you have any questions please contact the office on 02392 477110 or info@otw.org.uk

Over The Wall

Langstone Technology Park

Langstone Road

Havant

Hampshire

PO9 1SA

Charity No 1075361 & SCO43191
Should be Empty:

Camper Interest Form

Parent/Guardian Details

Referrer Details (if applicable or are referring a family)