2025 Camp Registration Form Camp Session:Please choose only one of the following sessions: Ages 5-17: June 16, 2025-June 27, 2025 Ages 5-17: July 28, 2025-August 7, 2025 Ages 18 and over: July 7, 2025-July 25, 2025 Please identify if your child (ages 5-17) is interested in attending both June and July sessions. Please note, placement will depend on space availability, and you will be contacted in the order of registration if a spot becomes available. Yes No Participant InformationParticipants Full Name(Required) First Name Last Name Preferred Name/NicknameDate of Birth MM slash DD slash YYYY AgeGenderPlease Select OneMaleFemaleOtherPrefer not to sayPlease select participants T-Shirt SizePlease Select the Correct SizeExtra Small (XS)Small (S)Medium (M)Large (L)Extra Large (XL)Extra-Extra Large (XXL)Please select participants sweatshirt sizePlease Select the Correct SizeExtra Small (XS0Small (S)Medium (M)Large (L)Extra Large (XL)Extra Extra Large (XXL)Parent/Guardian Name(Required) First Name Last Name Primary Contact Number(Required)Email Address(Required)Home Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Information:Emergency Contact(Required) First Name Last Name Phone Number(Required)Relationship to ParticipantSecondary Emergency Contact (Optional) First Name Last Name Phone Number(Required)Relationship to ParticipantMedical Information:Primary Diagnosis (If Applicable)Other Conditions or DisabilitiesAllergies (Food, Medications, Environments)(Required)Dietary Restrictions(Required)MedicationsPlease provide medication name(s), dosage amount, instructions, and whether it is to be taken during camp hours.Seizure History (Y/N) Yes No If Yes, Please Describe Frequency and TriggersPlease include date of last seizure and if they are controlled with medication.Toileting NeedsMobility NeedsCommunication NeedsPlease indicate whether your child is non-verbal or uses sign langue, and provide any supports or devices your child uses to communicate.Additional Support & Accommodation NeedsWill Support Staff Be Attending Camp? Yes No If so, please provide Name, Contact Information, & Agency InformationActivity ParticipationSwimming AbilityActivity RestrictionsPlease explain.Special Interests or Goals for CampPlease explain.Consent & Release FormsPhoto/Video Release I Agree to Photo/Video ReleaseI understand that there may be photos & videos taken while participating at Camp Laugh-a-Lot. The Camp, their partners and sponsors have my permission to use these photos on their social media sites, websites, and other marketing materials. Consent & Participation Agreement I Agree By submitting this form, I voluntarily provide my information and authorize Arc Human Services to use it to facilitate participation in the Camp Laugh-a-Lot program. I understand that participation in camp activities is optional and that necessary precautions will be taken to promote a safe and enjoyable experience. Additionally, I acknowledge that I have reviewed and understand all relevant guidelines, policies, and requirements for participation. Δ
