Celiac Strong Camp Inc
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Celiac Strong Camp Registration Request Form
for Campers (ages 7 - 16) & for CIT's (age 17)
We are pleased to be hosting Celiac Strong Camp for our 6th year!
The camp fee is nonrefundable.
Campers must be between the
ages of 7 through 16
by start date of camp to register as a camper.
Cabins are
rustic
and do not have air conditioning.
To be a CIT (Counselor in training), you must be outgoing, responsible, able to adapt, self-starter, like to work with children, willing to accept different tasks from cleaning, assisting in program and anything to help keep camp fun, safe and clean. You will take direction from the Program Director.
We need volunteers, both men and women, as this camp is run strictly by volunteers. No one is paid.
If you are 21 years or older & wish to be considered to be a camp counselor or 18 and older, you may be an activities counselor, please complete a
Volunteer Registration
. We will contact volunteers based on registration needs. We will be required to perform background check as well as a phone interview, completed application, references and camper’s packet.
Thank you for your interest in volunteering & assisting in making this camp a success.
*
Indicates required field
Registration for Camper (age 7 - 16) or Counselor in training (age 17)
*
Camper, age 7- 16
Counselor in training, age 17
Name of Camper (age 7 - 16) or CIT (age 17)
*
First
Last
Camper's Gender
*
Male
Female
Age on 8/12/2020
*
7
8
9
10
11
12
13
14
15
16
17
Date of Birth
*
Must be between the ages of 7 and 16 on 7/24/16
Email, please double check as this will be used for primary communication
*
Camper's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Camper's Primary Phone Number with area code xxxxxxxxxx
*
Please enter camper's primary phone number for first point of any contact. Please enter numbers only, for ex: 5852300363
Camper's T-shirt Size (in August)
*
Youth Small (4-6)
Youth Medium (8 - 10)
Youth Large (12-14)
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
This will be my child's ______ year at camp
*
1st
2nd
3rd
4th
5th
6th
7th
Would like to bunk with - first and last name: (not guaranteed, but will do our best to try to accommodate) We assign cabins by age catagory
*
Not guaranteed to bunk with your selection, but we will try to accommodate your request. We assign by ages. Do not request if their ages are different.
Is a lactose free diet required for Camper? Please note that we will not be able to accommodate any other diet other than gluten free & lactose free.
*
Yes, Lactose Free Diet required
No
Please check yes if lactose free diet is necessary.
Celiac Strong Camp will not be able to accommodate any other dietary needs, intolerance, allergies and / or sensitivities (other than gluten and lactose free). Please know we will not assume responsibility for any other dietary constraints. We regret the inconvenience that this poses to attendees and appreciate your understanding of our policy. By typing your name, you agree and understand this policy.
*
type yes, and your initials if you understand and agree.
I agree: ​Release of (Hold Harmless Agreement) Liability and Assumption of Risk Agreement: 1. The risk of injury from the activities involved in this program, Celiac Strong Camp, Inc., is sufficient, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and. 2. I, KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and. 3.1, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Celiac Strong Camp Inc., its officers, officials, agents and/or employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ("Releases") .WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.
*
If you agree, type yes, followed by parent's name, for example: Yes, Christina McGlynn
How did you hear about Celiac Strong Camp?
*
Please let us know how exactly you found out about Celiac Strong Camp. For example: Celiac Walk in Rochester, Celiac Walk in Syracuse, Facebook search, yahoo search, google search, friend, etc. Detailed responses help us in advertising. Thank you.
Camper Resides with (check all that apply)
*
Mother
Father
Guardian or Step-parent
Name of Mother or Guardian
*
First
Last
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Relationship to Child
*
Address of Mother or Guardian
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone for Mother or Guardian (numbers only)
*
Cell Phone for Mother or Guardian (numbers only)
*
Work Phone for Mother or Guardian (numbers only)
*
Mother or Guardian's Email
*
Would you like to be considered to become a volunteer? Mom or guardian (Must be 21 years old to volunteer).
*
Yes, I can volunteer
No, I cannot volunteer
Name of Father or Guardian
*
First
Last
Relationship to Child
*
Address of Father or Guardian
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone for Father or Guardian (numbers only)
*
Cell Phone for Father or Guardian (numbers only)
*
Work Phone for Father or Guardian (numbers only)
*
Email for Father or Guardian
*
Would you like to be considered to become a volunteer? Dad or guardian (Must be 21 years old to volunteer).
*
Yes, I can volunteer
No, I cannot volunteer
How would you like to pay for registration?
*
By mail
By Pay Pal (fees will apply)
By Phone (fees will apply)
Please select your preference on making your registration payment.
Comments / Notes
*
Submit