2024 Adaptive Family Camp | Family Registration Form

2024 Adaptive Family Camp | Family Registration Form

Welcome to our 9th season at the A/U Ranches' 100 Elk Outdoor Center in Buena Vista, Colorado!

The dates of this year's program are:
- Monday, October 14 – Saturday, October 19
Thank you for taking time to complete this part of the registration process. All family members participating in the program can be registered using this form. It takes approximately 20–30 minutes to complete, and it must be done in one session. (If you'd like to type your answers in a separate file and then paste them into the registration form, you may preview the questions by clicking here.)

Questions with a red * require a response.

Registration is due by Monday, September 16.
❤️ Loved one information ❤️

We're so delighted your loved one will be joining us! Please complete this section on behalf of them. Following this section, there is a "Household Information" section where you can register yourself and other family members who are participating.
Loved one's name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Loved one's date of birth*

MonthDayYear
Date
Loved one's gender*

MaleFemale
What is the current living situation of your loved one? (i.e. lives in family home, residential facility, group home, etc...)*

Help us get to know your loved one 🙂
This section helps us learn more about your loved one so we can do our best to embrace and engage them lovingly. Please feel free to share as much detail as you'd like so we can better meet your family's needs.
- If this is your loved one's first CherishAbility program, please complete all of the questions below.
- If your loved one has **recently** participated in a program, please feel free to share as much detail as you'd like, or simply write "already on file."
Please share your loved one's likes, dislikes, interests, talents, hobbies etc. in the box below. (The more information the better. 💗)*
What are some of your loved one's favorite activities?
What are some of your loved one's "super powers"?
Is there anything in particular your loved one is looking forward to?*
Would you be willing to share how your loved one engages with Christian Science and what their favorite ways to do so are, i.e. work with a practitioner, listen/read the weekly Bible Lesson, attend Sunday School, attend church services, etc.?*
Please tell us about a typical day for your loved one. Do they go to school? Are they homeschooled? Do they work and/or participate in day-programs or other specialized programs? What is their interaction with their community?*
How does your loved one respond to large and small group settings?*
How does your loved one like to receive information about new activities? (i.e. the use of visual schedules, visual demonstration, a Iist of rules, Picture Communication Symbol, in advance, just before an activity, etc.)*
How can staff best support your loved one in activities, situations, or environments if they become overly excited, agitated, or overwhelmed? Are there any behaviors your loved one demonstrates that would help staff to recognize if an adjustment is needed?*
If applicable, please share any behavior plans implemented at home, school, or work. *

Care and Emergency Contact Information

The A/U Ranches is a place of healing and growth at which prayer is the first and primary means of care. We welcome all students of Christian Science, without judgment. To facilitate a harmonious experience please let us know how we can support your family.
Does your loved one have any dietary restrictions or preferences that we should know about? (i.e. vegetarian, vegan, etc.)*

YesNo
Does your loved one have any health conditions or needs we should be aware of?*

YesNo
If you answered "yes" to any of the questions above, please explain anything you would like us to know to better prepare and help care for your loved one.
Medications: The Christian Science care providers do not dispense medicine, and per ACA requirements, prescription and over-the-counter medicines must be kept under lock, except when under the control of a parent/caregiver managing this.*

My loved one will not bring any medications to camp.My loved one's medications will be managed by our family/caregivers.
Permission to Treat (loved one):*

A. I authorize and request 100 Elk in cases of health emergency to make any and all appropriate and reasonable health treatment decisions. I understand this may include but is not limited to engaging a Christian Science practitioner, engaging a Christian Science nurse, providing first aid/CPR, contacting emergency medical services, providing emergency transportation, and admitting my loved one into a clinic or hospital. I understand that every effort will be made to reach the emergency contact as soon as possible. However, if deemed necessary before contact can be made, I also grant permission to receive such emergency care.B. I refuse to authorize any form of medical treatment beyond what is required by state law, and I release 100 Elk from all liability if I cannot be reached in an emergency.
If you answered "A" to the previous question, simply type "N/A" in the space below. If you answered "B" to the previous question: Please specify any actions that you authorize to be taken on behalf of your loved one. (This follow-up question is an American Camp Association requirement for parents/guardians who refuse medical treatment.) *
Is there any other information you would like us to know about your loved one in order to prepare for a harmonious experience?*
In the case of minors: I grant permission for my loved one to participate in all activities at 100 Elk, unless otherwise noted above. Parent/Guardian or Caregiver Name:
Parent/guardian or Caregiver e-signature

Clear

Multimedia Photo Release Agreement
MULTIMEDIA/PHOTO RELEASE AGREEMENT

CherishAbility reserves the right to use photos, video footage, and/or fruitage of staff, adult participants and guests from CherishAbility funded activities in printed and electronic publications.

This agreement grants CherishAbility the right to publish, distribute, and share such images, as described above for the following uses:

● Print

● Electronic media, including publications in PDF format, Websites and Social Media

● Audio/Video

● Promotional Uses (without attributions)

Submitted images become the property of CherishAbility and will not be shared with other organizations without written consent of the person(s) appearing in the photo(s) and/or video(s).

CherishAbility reserves the right to modify such images, at its discretion. This agreement also authorizes CherishAbility to store images internally for future reference and reuse.

It is our policy not to credit individuals whose images and/or fruitage have been submitted for use in these publications, unless specifically requested and authorized.

All shared images shall be the original work of the person sharing the images and are not to violate any copyright, contract, or other property rights of any person or organization.

The signee is not to share such images with other organizations for commercial use without CherishAbility’s explicit written consent. Such images can be used for personal and professional portfolio purposes.

Acceptance of this policy is assumed unless otherwise communicated in writing to CherishAbility. It is the responsibility of participants, chaperones, guests, or their legal guardians/conservators/caregivers to submit, in writing, exclusion from all multimedia/photo publications.
I have read and agree to the Multimedia Photo Release AgreementPlease exclude my family and me from all multimedia/photo publications.Other

Tuition and Payment
Tuition for this program includes all meals, accommodations, activities, and a t-shirt for each participant.
- $1425/person
- $1525/person (includes airport shuttle)
Payments may be made by check or online.

To pay by check, please mail a check payable to:

CherishAbility

555 S.E. MLK Blvd.

Suite 105, #6508

Portland, OR 97214

To pay online, please use the payment button on the next page.

Registration is due by Monday, September 16

Payments are due by Sunday, October 1
At this time, I will:*

make a full online payment (use payment button on the next page)apply for partial or full financial assistance
Finances should not prohibit your family's participation in this opportunity. As with all of our programs, financial assistance is available by completing the CherishAbility Financial Assistance Application, which can be found on the website by clicking here.

THIS SECTION IS FOR FULL ONLINE PAYMENTS ONLY — otherwise, please SKIP TO THE NEXT QUESTION (at the bottom of this page) to prove you're not a robot. 🤖
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Adaptive Family CampTuition
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❤️ Loved one information ❤️

Help us get to know your loved one 🙂

100 Elk Activity Offerings

Everyday Living Skills

Care and Emergency Contact Information

Household Information

Multimedia Photo Release Agreement

T-shirts

Tuition and Payment