When

Saturday, July 11, 2020 at 8:00 AM PDT
-to-
Saturday, July 18, 2020 at 2:00 PM PDT

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Where

Temescal Gateway Park

Pacific Palisades, CA 90272

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Contact

Deborah Green
Sickle Cell Disease Foundation of California
909-743-5226
deborahg@scdfc.org

Camp Crescent Moon 2020 - Medical Team Application

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Applicant Information

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    Profession: (check all that apply)

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    Patient Population:

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  • Certifications:

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  • Dietary Preference (check all that apply):

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  • Upon submission of this application, you will receive the following documents for completion: 1. Applicant Release & Authorization (for background check) 2. Medical History Form 3. Immunization Update (PPD, Tetanus & Hepatitis B) 4. Emergency Contact List


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