Camp Abilities Delaware Registration & Medical History Form

Camp Abilities Tucson Registration & Medical History Form
Camp Abilities Tucson 2025
Sunday, June 1- Saturday, June 6
Arizona State Schools for the Deaf & Blind
Tucson, AZ

Camp Abilities Tucson costs $299 per participant. If you need financial assistance to cover the camp fee, your local education agency, vocational rehabilitation department, or Lions Club may be able to help. We are happy to provide a letter about the educational and vocational programming at camp. We have limited scholarships available; contact us at CampAbilitiesTucson@gmail.com if the cost of camp is a hardship to your family. You can pay online via our website or send a check written out to Never A Loss of Vision to 7220 E Bellingham Drive, Tucson, AZ, 85730.

Your athlete will also need a medical form signed by a doctor. You can download that form here or we can mail it to you.

Camp Abilities Tucson is an educational sports camp for athletes who have visual impairments. Participants who present the following behaviors are not a match for Camp Abilities Tucson: biting, kicking, scratching, hitting, self-injurious behavior, elopement, verbal or physical threats to self and/or others, continuous noncompliance.

The Camp Abilities Tucson Leadership Team
Maria Lepore-Stevens, Program Director
Kim Egleston May, Operations Director
Jeff May, Community Affairs Director
Devyn Adams, Assistant Program Director
Athlete Name*

First NameLast Name
Athlete Birth Date*

MonthDayYear
Athlete Grade in Fall 2025*
Athlete Gender*
Athlete Pronouns
Parent/ Guardian 1 Name*
Parent/ Guardian 1 Phone Number*
(xxx) xxx-xxxx
Parent/ Guardian 2 Name
Parent/ Guardian 2 Phone Number
(xxx) xxx-xxxx
Do you prefer phone calls or text messages?*

Phone callsText messagesNo preference
Best Contact Email Address*
example@example.com
Athlete Email Address
If athlete wants to be included on emails. All emails to athletes under 18 will also be sent to guardians.
Athlete Primary Address

Street Address

Street Address 2

CityState

Zip Code
Athlete T-Shirt Size*
Which program are you registering for?*

Youth Camp (ages 7-17): Our main program is overnight camp for athletes ages 7-17.Adult Camp (ages 18+): Our adult program is designed for athletes with multiple disabilities including visual impairment who do not currently have the leadership or independence skills be on our staff.Coach in Training (ages 15-17): Teenagers with an interest in developing leadership skills can join our inclusive CIT program. This program is designed to teach leadership skills in a sport setting to young people with and without visual impairments. Must have previously attended camp. INTERVIEW REQUIRED AFTER APPLICATION.
Emergency Contact

Please list an emergency contact if the parents/ guardians above are unavailable in an emergency situation.
Emergency Contact Name
Emergency Contact Phone Number

Assumption of Risk and Authorization For Emergency Medical Treatment
Athlete Name

First NameLast Name
Camp Abilities Tucson has an established emergency medical treatment plan. In case of a minor injury or illness, authorized trained personnel may administer first aid or medication. We have a nurse and many coaches certified in First Aid. In cases of serious injury or illness, personnel will call for emergency medical treatment or provide transportation to emergency services as needed. In all cases, a parent/guardian will be called regarding injuries and/or illness.

I, as parent/guardian with legal responsibility for the participant named above, authorize Camp Abilities Tucson to administer first aid, to call for emergency medical treatment, or to provide emergency transportation, as described above, for the participant named above. I further agree to bear all costs of emergency services provided in cases of injury or illness.

I understand that participation in the Camp Abilities Tucson program has risks due to the physical demands that are placed on a participant during physical activity and recreation participation, and that during physical activity there is potential risk of physical injury. I agree that I am solely responsible for my participant’s involvement and for their physical and emotional well-being. I understand that the program activities are voluntary and after receiving a copy of the activities, I am choosing for my participant to partake in each activity to whatever degree possible, with the child's physical, emotional and medical conditions considered.

I affirm that the participant’s health is good, and that they are not under a physician's care for any undisclosed condition that bears upon their fitness to participate in physical education, recreation and aquatic activities. I willingly and knowingly assume risk for the participant, myself, my heirs, family members, executors, administrators, and assume all risk of physical injury and emotional upset which may occur during any aspect of the program; and hereby agree to hold Camp Abilities Tucson, its employees, instructors, facilitators, and volunteer counselors/coaches harmless for any liability arising out of the child's participation in the program.
Parent/ Guardian Signature (or Athlete Signature if Over 18)*

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Authorization to Use Audiovisual Products

Camp Abilities Tucson/ Never A Loss of Vision has frequent occasion to illustrate and explain its program and activities for volunteer recruitment, fund raising, enhancing community awareness, news releases, brochures, reports, etc. Toward these efforts it is most beneficial to use photographs of our athletes/participants. However, we would never intentionally offend our athletes/supporters by doing these things without their understanding and consent. If you feel comfortable in assisting us in audiovisual productions, we would appreciate your consent.
As parent/guardian with legal responsibility for the participant named above, I*

DO give consent to Camp Abilities Tucson to use any audiovisual products for such purposes as described above.DO NOT give consent to Camp Abilities Tucson to use any audiovisual products for such purposes as described above.
Parent/ Guardian Signature (or Athlete Signature if Over 18)*

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Camp Abilities Tucson Registration & Medical History Form

Emergency Contact

Athlete Sport and Vision Information

Health History

Medical Provider and Insurance Information

Assumption of Risk and Authorization For Emergency Medical Treatment

Authorization to Use Audiovisual Products