Print and mail completed form to:
New Jersey WAVE
c/o Voorhees Pediatric Facility
Attention: Tricia Cunningham
1304 Laurel Oak Road
I agree to allow the Wave staff to review the personal and
medical information contained in this packet. I also agree
to have this information reviewed by the physicians
providing medical clearance for WAVE getaway
participation.
_____________________________ _________
Applicant) (Date)
____________________________ ___________
(Parent) (Date)