Application Forms for Follow Your Heart Camp

Please fill out the application and provider forms below and send to:

Pediatric Heart Center

1 Hoppin St., Suite 304
Attention: Louise D’Amato
Providence, RI 02903

You can also send the forms via fax to 401-444-7619 or email at [email protected].

Application Forms

Application forms must be filled out completely by you (the parents) and returned by May 31. Incomplete or late forms will not be considered. We will start processing your application before the provider forms arrive. 

• Checklist (PDF)
• Camper Application Form (PDF)
• Authorization, Waiver of Liability and Release (PDF)

Applications are currently not being accepted, but we will update this page as soon as they begin again. 

Provider Forms 

Please fill in as much information as you can before dropping off at provider’s office. Do not wait for these forms to be completed to send in your application. We understand these forms will be returned at a later date. We will start processing your application before the provider forms arrive. Please do not delay.

• Primary Care Provider Physical Exam Form (PDF)
• Pediatric Cardiologist Camper Participation Form (PDF)