Camper Registration Form Please enable JavaScript in your browser to complete this form. - Step 1 of 2Registration Dates: February 1, 2025 – June 1, 2025LayoutCamper Name *FirstLast Camp Details Camp Dates: Jun. 23 – 27 and Jun. 30 – Jul. 3 Time: 8:30am – 12:30pm Program Cost: $550 *Must commit to the entirety of the two-week period *Cancellations made after June 1st will be final and nonrefundable. LayoutCamper Gender *MaleFemaleNon-binaryCamper Birthday *Camper Age *LayoutGuardian Name *FirstLastEmail *Phone *Mailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMedical History Was your child enrolled in school for the 2023-2024 school year? If yes, please indicate the school. If no, please explain. *YesNoWas your child enrolled in school for the 2023-2024 school year? Explanation *Should exposure to nature and amount of physical exercise be limited? If yes, please explain. *YesNoShould exposure to nature and amount of physical exercise be limited? Yes ExplanationDoes child have any allergies? If yes, please explain. *YesNoDoes child have any allergies? Yes ExplanationPlease provide a comprehensive list of any allergies that the camper may have. This information is crucial for ensuring their safety and well-being during their time at the camp.Is child prescribed an inhaler or epi-pen? If yes, please explain. *YesNoIs child prescribed an inhaler or epi-pen? Yes ExplanationRelevant Medical Diagnoses Please list any medical diagnoses or conditions that are pertinent to the camper's health and well-being. This information will help us provide appropriate care and support during their stay at the camp. Any medication required for camper during camp hours should be administered before or after entering the camp.Is there anything else we should know?NextWhich Program do you want to register for? *June 23, 2025 - July 3, 2025, June 30th - July 3rd - $550.00Price Includes a 3% transaction fee from Stripe Payment. Campers must commit to the entirety of the two week period. Total$0.00Credit Card Payment *LayoutChild Eligibility Is your child capable of: Toilet Hygiene *YesNoDressing (with exception of shoe tying and other fasteners) *YesNoEating/Drinking *YesNoAmbulation (i.e. able to walk on level and non-level surfaces, stairs, inclines, and declines) *YesNoSelf-advocating for basic wants/needs verbally and/or non-verbally (i.e. “I’m Thirsty” or using an Augmentative and Alterative Communication) *YesNoConsistently following a minimum of one-step directives *YesNoIf you check "no" to any of the boxes above, we are unable to provide services for your child at this time. For any questions or concerns please email us at info@abilitysportscamp.com or call us at (847) 873-5659. Agreement Forms *Terms and ConditionsLiability Waiver Agreement *Liabilities WaiverParental Consent and Authorization for Medical Treatment Form Agreement *Parental Consent and Authorization for Medical Treatment FormPhotograph Release Agreement *Photography ReleaseBy checking the boxes and providing your digital signature below, you confirm that you have opened, understood, and agreed to be bound by ALL terms, policies, releases and waivers contained in the registration documents provided by Ability Sports Camp of Chicago, LLC. LayoutElectronic Signature *Date *Single Line TextSubmit
