Texas Asthma Camp


	Texas Asthma Camp Info

	Camper Online Registration

	General Info/What to Bring
	Forms
	Map to the Camp

	2008 TAC Brochure

Call the camp at:
(903) 877-7075

GroupM7 design

Far from ordinary.
Close to home.

Your online registration will be processed when your $15 registration fee has been received at the following address:

Texas Asthma Camp
Attn: UTHCT Public Affairs
11937 U.S. Hwy. 271
Tyler, Texas 75708-3154

If you would like to receive a financial aid application, please mail your $15 registration fee to reserve a space for your child. A financial aid package will be mailed to you immediately. The registration fee is required regardless of financial aid status.

Contact/Camper Information
One Week Only	June 15-20
Name of Camper:
Address:
City:
State:
Zip:
Email:
Day Phone:
Evening Phone:
Date of Birth:
Age While at Camp:
Sex:	Male Female
Parent's/Guardian's Name:
Asthma History
How many years has your child attended the Texas Asthma Camp for Kids?
How did you first hear about the Texas Asthma Camp?
How many years has your child had asthma?
How many days of school has your child missed this year because of asthma?
How many times has your child been to the ER for asthma in the last 6 months?
Has your child been in the hospital in the last six months due to asthma?		Yes No
Has your child used a nebulizer during the last six months?		Yes No
What is a peak flow meter?
List the asthma medications your child's doctor has prescribed.
List the asthma medications your child actually takes.
Does your child have any other health or developmental problems? (i.e. ADHD, allergies)		Yes No
If yes, list them.

General Information
New Patient Appointments: (903) 877-3451
Emergency Room: (903) 877-7171
(903) 877-7806