2025 AYC | Registration Form

2025 CherishAbility Adaptive Youth Camp

at CedarS Camps

Session 4 | Sunday, July 20 – Friday, August 1, 2025

Thank you for taking the time to complete this registration form. It will take approximately 30 minutes and needs to be completed in one session.

To assist you, a complete list of the registration questions can be downloaded by clicking here.

Camper Information

We're delighted your child will be joining us! Please complete this section on behalf of them. Following the "Camper Information" section, there is a "Household Information" section for the parent/caregiver.
Camper's name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camper's date of birth*

MonthDayYear
Date
Camper's grade next school year*
Camper's gender*

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

Personal information

We would love to know your child better so we can make the camp experience as fulfilling as possible for them. Please feel free to share as much detail as you'd like so we can better meet your child's needs.
Please share your child's likes, dislikes, interests, talents, hobbies etc. in the box below. Is there anything in particular your child is looking forward to? (The more info the better!) *
What goals do you have for your child as a result of participating in this program? *
Would you be willing to share how your child engages with Christian Science and what their favorite ways to do so are, i.e. work with a practitioner, listen to and sing hymns, listen to or read the weekly Bible Lesson, attend Sunday School, attend church services, etc.?*
Please tell us about the school or the program your child is in (if applicable).*
How does your child respond to large and small group situations?*
How does your child like to receive information about new activities? (i.e. the use of visual schedules, visual demonstration, Iist of rules, Picture Communication Symbol, etc.)*
When does your child like to receive information about new activities? (i.e. before they arrive, as the activity starts, etc.)*
Are there activities or situations that frustrate, agitate, or overly excite your child? If so, please share what they are and different ways to work through them so we can best support your child.*
How can staff best support your child in situations or environments that may be new or unpredictable? Are there any behaviors your child demonstrates that would help staff to recognize if an adjustment is needed?*
What strategies would you recommend to help calm your child?*
Please share behavior plans, accommodations, and modifications that are implemented at home, school, or work to help your child be successful. *

Household Information

Please provide parent/caregiver information below.
Parent/Caregiver name*

First NameLast Name
Address (if different from your child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone number*
Do you have any dietary restrictions or preferences (i.e. vegetarian, vegan, etc.) you would like us to know about?*

YesNo
Permission to treat (for the parent/caregiver):*

A. I authorize and request CedarS Camps 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, admittance into the camp's Christian Science care facility, providing first aid/CPR, contacting emergency medical services, providing emergency transportation, and admittance 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 CedarS Camps from all liability.
If you answered "B" to the previous question: Please specify any actions that you authorize to be taken on your behalf. (This follow-up question is an American Camp Association requirement for parents/guardians who refuse medical treatment.)
Emergency contact if different from your child's

First NameLast Name
Emergency contact phone number if different from your child's
Is there any other information you'd like to share to help make this a positive experience?*

Release of Liability (ROL)
In consideration of the risk of injury while participating in the 2025 CherishAbility Adaptive Youth Camp (the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge CherishAbility, located at 555 MLK Blvd. Suite 105 #6508, Portland, OR 97214, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.

I agree to indemnify and hold harmless CherishAbility against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If CherishAbility incurs any of these types of expenses, I agree to reimburse CherishAbility.

I acknowledge that CherishAbility and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of CherishAbility.

I ACKNOWLEDGE THAT THIS ACTIVITY MAY INVOLVE A TEST OF A PERSON'S PHYSICAL AND MENTAL LIMITS AND MAY CARRY WITH IT THE POTENTIAL FOR DEATH, SERIOUS INJURY, AND PROPERTY LOSS. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE CherishAbility AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST CherishAbility FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of CherishAbility, its agents, and employees.

In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. The participant and CherishAbility agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.
I, the undersigned, affirm that I am freely signing this agreement on behalf of my child. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.
Parent Signature for camper ROL *

Clear
Date*

MonthDayYear
Date

Multimedia Photo Release Agreement
CherishAbility and CedarS reserve the right to use photos, video footage, and/or fruitage of staff, adult participants, and guests from CherishAbility and CedarS funded activities in printed and electronic publications.

This agreement grants CherishAbility and CedarS 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 of youth participants become the property of CherishAbility and CedarS and are not to be shared by the signee with other organizations for commercial use without CherishAbility’s or CedarS's explicit written consent.

CherishAbility and CedarS reserve the right to modify such images, at its discretion. This agreement also authorizes CherishAbility and CedarS 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 signee and are not to violate any copyright, contract, or other property rights of any person or organization.

Such images can be used for personal and professional portfolio purposes.
Acceptance of this policy is assumed unless otherwise communicated in writing to
CherishAbility and CedarS. It is the responsibility of participants, 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 and Photo Release Agreement.Please exclude my child and me from all multimedia/photo publications.Other

Transportation
Please indicate how your family will arrive at camp.*

DrivingFlying
Tuition and Payment
We offer two levels of participation.
- Level 1 is for campers who are ready to attend camp by themselves—with adaptations—and they stay in a cabin with their peers.
- Level 2 is for campers who are not yet ready to attend camp by themselves, and they stay overnight in a cabin with a parent.
*TUITION:
- Level 1 | Camper attends by themselves: $2100/week
- Level 2 | Camper attends with a parent: $2800/week
*Finances should never prohibit participation—assistance is available for up to the full cost of tuition and travel. Click here to access CherishAbility's Financial Assistance Application.

STORE ACCOUNT: There is an additional $30/person/week refundable charge for the camp store deposit. The store account allows campers to purchase items from the store and covers laundry costs. Items like t-shirts, and snacks can all be deducted from this account. Any balance remaining at the end of camp will be returned.

Payments may be made by check or PayPal.
At this time, I will:*

make an online payment (a separate invoice will be emailed).mail a check for the partial or full amount.apply for financial assistance.
If you will be making a partial payment, please indicate the amount you are able to contribute below.
Registration is due by Friday, May 9.

Payments must be received by June 1.

To pay by check, please make the check payable to: CherishAbility

Mail checks to:

CherishAbility
555 SE MLK Blvd.

Suite 105, #6508

Portland, OR 97214
Enter the message as it's shown*
Should be Empty:

Camper Information

Personal information

CedarS Camps Activity Offerings

Everyday Living Skills

Care and Emergency Contact Information

Household Information

Release of Liability (ROL)

Multimedia Photo Release Agreement

T-shirt size

Transportation

Tuition and Payment