Kids Camp Registration | Spina Bifida of Louisiana Family Conference 2023

Kids Camp Registration | Spina Bifida of Louisiana Family Conference 2023

Kids Camp, in conjunction with our Family Conference, is opened to children and teenagers living with Spina Bifida and their siblings. Camp will consist of arts and crafts and other planned activities. Our Family Conference will take place at the DoubleTree by Hilton - New Orleans Airport in Kenner. (2150 Veterans Blvd, Kenner LA 70063). A separate registration form must be filled out for each participant.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Date
Child's Age*
Child's Gender*

MaleFemale
Emergency Contact Person *
Emergency Contact Number*
Please enter a valid phone number.

Tell Us More About Your Child/Camper
Does Your Child Have Spina Bifida or Another Healthcare Condition/Disability?*

Spina BifidaNoAnother Healthcare Condition/Disability
Will This Be Your Child's First Time Attending "Kids Camp" as Part of Our Family Conference?*

YesNo
Tell Us A Little More About Your Child to Help Us Make The Best Experience for Your Child During Camp.
Including General Mood, Personality, Interests, etc.

Tell Us About Your Child's/Camper's Medical Needs

We will have trained staff and medical personnel to tend to your child's medical needs during the hours of Kids Camp.
Will Your Child Need to Be Cath During Kids Camp?*

YesNo
Does Child Need Assistance with Catheterizing?*

Yes, Child Requires AssistanceNo, Child Can Cath Independently
Schedule/Frequency*
Catheter Size (Ex: 12FR)*
Additional Comments About Catheterizing
Please include any additional information about prep or anything else that you feel is important for staff to know.
Will Your Child Need to Be Administered Medication During Kids Camp?*

YesNo
Medication Name*
Dosage*
How Will Medication Be Taken?*
Time*
Special Instructions For Medication
Additional Comments About Medication
Please include any additional information that you think that is important for staff to know regarding medication.
Does Your Child Have any Dietary Restrictions and/or Allergies That We Should Be Aware of?*
If none, please put none.
Is There Any Additional Information That You Would Like Us To Know About Your Child?
Please include any information that you think that is important for staff to know when caring for your child.
Today's Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Tell Us More About Your Child/Camper