Grandparents Registration

Grandparents Registration
Individual with CHARGE

First Name Last Name
Email
example@example.com
Would you like to be on our mailing list:

YesNo
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Grandparent 1

First Name Last Name
Grandparent 1 T-Shirt Size
Please note that we do our best to insure t-shirts are correctly ordered, we do not buy extra. Please make sure the desired shirt size is correct. T-shirts are true to size.
Grandparent 2

First Name Last Name
Grandparent 2 T-Shirt Size
Please note that we do our best to insure t-shirts are correctly ordered, we do not buy extra. Please make sure the desired shirt size is correct. T-shirts are true to size.

Arrival/Departure Information
This registration is specifically for grandparents of individuals with CHARGE syndrome. Families of individuals with CHARGE should use the family registration form.

Grandparents please complete this form for you. This should not include counts of any other family that is attending.
Will be

Staying at Camp Allen for the entire weekendDay Guest (Saturday Only)
Arriving

Friday (check in starts at 3pm)Saturday
Departing

SaturdaySunday
Total Number of guest you are registering in this registration.
Total Number of guest staying Friday Night in this registration.
Total Number of guest staying Saturday Night in this registration.
Total Number of Day Guests in this registration.

Special Accommodations
Camp Allen's hotel rooms have two double beds in each room; TV's nor refridgerators are provided in the hotel rooms. Camp Allen will provide a refrigerator located near the hotel rooms for guests to store medication only. If you desire, you are welcome to bring a small TV/DVD player, make sure you bring your DVD's. There is a TV lounge located in the Richardson Wing which has satallite. Please note this is a common area for all Camp Allen Guests. Children under the age of 18 should be accompanied by an adult.
Will need

Wheel Chair AccessSign InterperterSpanish Interpreter
Will need

Wheel Chair AccessSign InterpreterSpanish Inrerpreter
For Whom
Do you need any special arrangements regarding hotel rooms? If so, what are they?

Photo & Liability Release
I herby give The Texas Chargers, Inc. the right to photograph, video tape, and sound recored the acts, appearances, utterances of me/my son/my daughter/my ward/or any member in connection therwith and without limits as to time, to produce and reproduce the same or any purpose which, The Texas Chargers, Inc. deem properin the interst if internet, newspapers, television media, brochures, pamphlets, instructional material, books and clinical material, medical education, knoweldge, or research. All such photographs, teletapes, films and sound recordings shall be the exclusive property of The Texas Chargers, Inc. and I herby relinquish all rights, title and interests therein.

With respect to the foregoing matters, no inducemebts or primissions have been made to us/me to secure our/my signature(s) to release other than interntion of The Texas Chargers, Inc. to use or cause to be useed such as photographs, films ans pictures for primary purpsose of promoting and aiding The Texas Chargers, Inc. and its works. (its works include but not limited to providing photographs, films, pictures, or recordings to grant funders or other marketing needs)

Further, I understand and agree that photos, videos tapes, or recordings of any nature maybe use by the Texas School for the Blind and Visually Impaired for creating marketing materials and other needs as deemed appropriate by the Texas Charge Board Directors.
Type a question

Clear
This is to release and indemnify The Texas Chargers, Inc. from any liability to any party during your stay at Camp Allen. The Texas Chargers, Inc. requirements is that you/your family, guests, attendants, or any other person for whom you are acting as guardian or represenative, will assume full responosibility for anyone brought onto the premises for any damage or injury of any nature whatever that may incur to themselves, property, and Camp Allen property while on premises, and that you assume that your insurance coverage will extend to any such injury or damage.
Type a question

Clear
Should be Empty:

Grandparents Registration

Arrival/Departure Information

Special Accommodations

Photo & Liability Release