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Registration Forms

Camp Chihopi
June 14-17, 2013

If your child would like to attend Camp Chihopi, please download and complete the following forms and mail, email, or fax them by the indicated date.

The following forms and information are included:

2013 Forms (PDF)	Due Date
Registration Form	May 6
Liability Release/Parental Consents	May 6
Camp Contract	May 6
Medication List	May 6
Additional Medical Needs	May 6
Travel Plan	June 3

Send the above forms to:
Beverly Kosmach-Park
Children’s Hospital of Pittsburgh
Faculty Pavilion, 6th Floor
Abdominal Transplant Surgery
4401 Penn Ave.
Pittsburgh, PA 15224
Fax: 412-692-6116
E-mail: beverly.kosmach@chp.edu

For questions or concerns, contact Beverly Kosmach-Park at 412-692-6115 or e-mail beverly.kosmach@chp.edu.

Last Update
February 22, 2013

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