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Family Getaway Application
Qualifying Criteria
• Must have a child under 18 with a chronic illness or physical challenge who is currently being served by a Camp John Marc partner hospital or group. • Cystitis fibrosis patient served in the Dallas/Ft. Worth area under 18.
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Contact Information
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First Name
Last Name

First Name
Last Name
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Family Getaway Weekends are for family members who currently live in the same household and grandparents. The child with the qualifying medical condition must attend.
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First Name
Last Name
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(mm/dd/yyyy)

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Any information would be helpful to help us prioritize.
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Please select your 1st choice for attending a getaway.
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Please select your 2nd choice for attending a getaway.
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Please select your 3rd choice for attending a getaway.
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(mm/dd/yyyy)