Summer Camp Detailed Registration Form 2025

Camp Rockstar Camper Application

Summer 2025
Camper Information
Camper's Name

First NameLast Name
Camper's Birth Date

MonthDayYear
Camper's Shirt Size
Please indicate if size is Youth or Adult
Camper's School Attendance
Camper's Rising Grade
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Camper's Primary Disability
General Information
Below, please include all necessary medical information about the camper (including but not limited to) medical conditions, glasses/hearing aids, wheelchair/walker, seizures (do they have emergency medication for seizures), allergies, and medications.
How does the camper tolerate being outside/heat? Can they wear sunscreen?
Does the camper have any eating or feeding needs? Please include any dietary allergies, the level of assistance they require while eating (independent, full assistance, food needs to be broken into small pieces, etc.) and any special diet they may require.
Camp Rockstar asks that all parents/guardians supply lunch for their camper. Snack will be provided.
Does the camper have any toileting needs? Please include the level of support they need while toileting (independent, verbal prompts, monitor, full change, etc.). Do they require a diaper/pull up, menstrual care needs, etc?
Does the camper have any communication needs? Please indicate their preferable mode of communication and if they utilize an Augmentative and Alternative Communication (AAC) device, etc.
Does the camper present any behavioral needs? If so, please explain.
*Camp Rockstar reserves the right to deny children who exhibit verbal or physical aggression to maintain the safety of counselors and campers.
What else can you tell us about the camper? Please include their interests, fears, or any other information that may be useful during camp.
Who is allowed to pick your camper up from camp?
Photo Release Information

As the parent or legal guardian of the above named individual, I grant Camp Rockstar my permission to use the photographs taken during camp activities for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, social media and web content.
Signature

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By signing in the above box, you are indicating your agreement to release photos of the above named individual for Camp Rockstar use.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

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Date

MonthDayYear
Date
Submission of this form does not automatically constitute acceptance to Camp Rockstar. Application will be reviewed and families will be notified of acceptance to Camp Rockstar Summer 2025 on or before April 15, 2025.

Should you have any questions, please contact Camp Director, Jessica Partin, at jessica@camprockstarsc.com.
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Camp Rockstar Camper Application

Camper Information

General Information

Submission of this form does not automatically constitute acceptance to Camp Rockstar. Application will be reviewed and families will be notified of acceptance to Camp Rockstar Summer 2025 on or before April 15, 2025.