• 2026 iCAMP Camper Registration Form

    2026 iCAMP Camper Registration Form

    These forms are required for your children/participant to attend camp.

  • Camper's Information

  • Date of Birth*
     - -

  • NOTE - Children/Participant will need to be accompanied by a parent or caregiver if ANY of the following are required.

    • Need help using the bathroom or wear diapers or depends and need assistance changing
    • Need assistance changing clothes when applicable (usually on the water activities and pool)
    • Use a mobility device which requires assistance on rough and off-road enviroments
    • Use of precription medication(s) that must be taken during the time period the camper is at camp
  • Camper Swimming Ability*

  • Parents' Information

    Parent/Guardian 1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would you like to be reached while your camper is at camp?*

  • Parent/Guardian 2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would parent/guardian 2 like to be reached while your camper is at camp?

  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the camper in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.

  • EMERGENCY INFORMATION

    Emergency Contact #1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • EMERGENCY INFORMATION

    Emergency Contact #2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical / Health Information

  • Format: (000) 000-0000.
  • Does your camper have any food, medication or environmental allergies?*
  • Allergies? Check all that apply*
  • 0/150
  • Does your camper’s allergy/allergies require staff to monitor camper for symptoms, take action if a reaction occurs, or give emergency medication to your camper?*
  • Does your camper have a special health or medical condition?*
  • 0/150
  • Does the special health or medical condition require staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during camp hours?*
  • Is your camper currently using any medication, food supplement or medical food (such as electrolyte solution)?*
  • 0/150
  • If yes, does this medication, food supplement, or medical food need to be administered at the day camp?*
  • Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*
  • 0/150
  • Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?*
  • 0/200

  • Additional Medication

  • Check all that apply

  • If the camper has any medication to be administered at camp please include a detailed list by adding a file or scaned document below.  Include medication name, exact doesage and time.

  • If your child's medication meets any of these criteria:

    1. A physician's instruction is needed for a nonprescription medication (e.g. child is underage or underweight per the label instructions); or
    2. It is a sample medication without a prescription label; or
    3. The nonprescription medication is to be given longer than three consecutive days within a fourteen day period or is a topical product or lotion that is being used for a skin ailment and is to be given no longer than fourteen consecutive days; or
    4. The child is on a modified diet (an entire food group is eliminated); or
    5. The medication contains codeine or aspirin.

    ***The topical product or lotion and the physician's instructions exceed the manufacturer's instructions or use

     

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  • Payment and Statement of Understanding

  • Acknowledgement of Policies and Procedures I have reviewed and received a copy of the center's policies and procedures/handbook.*
  • Date Signed*
     - -

  • My Products

    prevnext( X )
      Camp Fee
      $125.00$125.00
        
      Total
      $0.00$0.00

    • Payment Methods

      Choose from one of the PayPal options to make your payment.

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