Camper Pre-Registration

Held at Harnischfeger Park – A Dodge County Park in Ixonia, WI July 22-25, 2024

Please complete the form below.

Have you attended the Team Up Camp before?(Required)

New Camper

Returning Camper

Child's Name(Required)

First Last

Name as it would appear on their nametag(Required)

Name

Gender(Required)

Male

Female

Parent's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent's Cell Phone Number - where they may be reached during camp(Required)

Email(Required)

Enter Email Confirm Email

Physician(Required)

Please list your primary care physician's name AND phone number.

Age as of July 22, 2024(Required)

Birthdate(Required)

MM slash DD slash YYYY

T-shirt size(Required)

Child Small 6-8

Child Medium 10-12

Child Large 14-16

Adult Small

Adult Medium

Adult Large

X-Large

XX-Large

As of July 22, 2024 my child will be: (check as many as apply)(Required)

4 years of age; I will attend camp with my child (Please complete Volunteer Registration Form)

5 years of age or greater with No Special Needs

5 years of age or greater with Special Needs: I will assist my child or provide a “buddy” to assist my child at camp. *Volunteer registration and Disability Info Sheet Required*

5 years of age or greater with Special Needs:Please assign a Carroll University “buddy” to assist my child at camp. * Disability Info Sheet Required*

13 years of age or greater and would like to be part of the teen group

13 years of age or greater and would NOT like to be part of the teen group

The following is a complete list of my child’s permanent and/or temporary disabilities: If none, write "None"(Required)

Adaptive equipment(Required)

None

Wheelchair

Walker

Other

Allergies(Required)

None

Latex

Bee Stings

Environmental

Food

Medicine

Please check ALL that apply.

Other allergies not listed above:

Allergens(Required)

If checked above, please list any specific allergies, and the type of reaction. Or write "None"

Life Threatening(Required)

Yes

No Allergies

Will your child require Team Up volunteers to administer medication? If yes, please explain(Required)

Does your child have any dietary restrictions? If so, please list.(Required)

Does your child have a history of seizures? If yes, please explain(Required)

For siblings attending camp-List any other concerns: (i.e. medical, behavioral, social/emotional) If not a sibling please write "N/A"(Required)

Do you want your child to participate in horseback riding?(Required)

Yes

Do you want your child to participate in the rock wall climbing? (There are volunteers there to assist with adaptations. If you are unsure, checking yes does not mean that your child will have to climb. They are just given the opportunity. They/You can always say no.)(Required)

Yes

How did you hear about camp?(Required)

For siblings attending camp, would you like them to be in a group together? This may not be possible if ages are too far apart or groups are too big.(Required)

Yes, please put siblings in the same group

No, put the in different groups

No preference

Not applicable

Permission to Photograph

Many of the wonderful camp experiences are photographed by family members and volunteers, along with occasional visits from local media. Your child's image or likeness (photographs, films, videotapes, electronic recording) may be used for publicity or publications to spread the word about Team Up! With Families and Team Up for Fun! Day Camp or to thank sponsors and volunteers.

Disclosure of Risk

In consideration of the opportunity afforded to my child to participate in the “Team Up for Fun!” Day Camp held at Harnischfeger Park, the undersigned, being a parent or legal guardian of the Child and in recognition of the possible danger to which the Child may be voluntarily subjected, including, but not limited to, fishing, horseback riding, hiking, adapted sports, and cooperative games, the undersigned hereby knowingly, freely, and voluntarily waive, on behalf of the Child, and the undersigned, any right or cause of action, of any kind whatsoever, arising as a result of such activity from which any liability may or could accrue and hereby authorize the participation of the Child in the “Team Up for Fun!” Day Camp to be held Monday, July 22nd – Thursday, July 25th , 2024 from 9:30am – 1:30pm.

I understand that safety measures will be taken and CDC guidelines will be followed in reference to COVID-19. Vaccinations are not required but are highly recommended.

Acknowledgement

I understand that reasonable measures will be taken to safeguard the health and safety of all participants, and that if I do not attend camp with my child, I will be notified as soon as possible in case of an emergency. If an emergency were to happen, I understand that my child will be taken to Memorial Hospital in Oconomowoc. In the event that I cannot be reached in an emergency, I hereby authorize the calling of a physician at my expense to provide whatever medical or surgical treatment is necessary.

It is expressly understood and agreed that Team Up! with Families, Inc., as well as their board members and volunteers, or any other participating organization shall not be responsible or legally liable for any losses of personal property or for any bodily injuries, or the results thereof, incurred and suffered by my child in connection with any activities or programs associated with “Team Up for Fun!” Day Camp.

I understand this information will be shared with camp volunteers such as group leaders, buddies, health aids, etc. as needed.

Acceptance of Terms(Required)

I am the legal parent or guardian of the above named camper, and have read and agree to the terms described above in permission, disclosure and acknowledgement.

Deadline This form must be submitted by May 26, 2024. If you have any questions please contact Bridget at (262) 490-8183 or teamupforfuncamp@gmail.com

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IMPORTANT LINKS

CONTACT INFORMATION

Team Up With Families - Katy's Kloset
404 Wilmont Dr D,
Waukesha, WI 53189
262-746-9034