Camp ROAR 2017 Interest Form

Interest Form for Camp ROAR 2017

The Food Allergy Institute of Charlotte will be partnering with PAK Charlotte again this summer to host summer Camp ROAR. Spots will be filled on a first come, first serve basis, please fill out the documentation requested on page 2 and email it to Raquel Durban, at your earliest convenience, but no later than March 10.

When: June 19-23, 2017, 8am – 12pm

Location: Pineville United Methodist Church, 110 S. Polk Street, Pineville, NC 28134.

Ages: This will be a drop-off camp for rising Kindergartners (5 years of age, on or before 8/31) through rising 8th graders. We will split into three age groups. For high schoolers, there are opportunities to be teenage ambassador volunteers.

Cost: $80/child; 10% discount for siblings

We are very grateful to The Food Allergy Institute of Charlotte as they will continue to be our Premier Sponsor and financial support for camp. Unfortunately, we were unable to obtain a grant for camp from FARE this year due to the restructuring of their grant schedule.

Activities: During camp, youth will have the opportunity to participate in typical fun camp activities such as arts & crafts and sports. In addition, children will participate in a variety of team-building and small group activities/discussions designed to encourage positive interactions with their food allergic peers. They will identify strategies and tools to address the challenges associated with food allergies, as well as how to recognize and utilize personal strengths and resources. Overall, we expect for the children to develop lifelong skills, lasting friendships, and amazing memories from their Camp ROAR experience!

We are looking forward to another great year and lots of fun at Camp ROAR 2017!


Page 2.

Please email this page with your responses to Raquel Durban at no later than March 10.  

  1. Participant’s name:
  2. Participant’s date of birth (mm/dd/yr):
  3. Grade level for 2017-2018:
  4. Food allergy/medical diagnosis:
  5. Would you like siblings to attend?
  6. Name/age:
  7. Name/age:
  8. Guardian/Parent name(s):
  9. Email address:
  10. Phone number:


On March 10, 2017, emails will be sent to participants that their camper’s spot has been secured. In this email you will find a registration packet that will need to be completed and returned, postmarked by March 31, 2017. With your registration packet, please enclose a check or money order for $80 made payable to Asthma & Allergy Specialists, PA.  There will be a sibling discount of 10% per additional camper. If you would like to be a parent volunteer or a teenage ambassador volunteer, please email Raquel with your availability.

Asthma & Allergy Specialists, PA

Attn: Raquel Durban

8045 Providence Road

Suite 300

Charlotte, NC 28277