Camp Ellellbee @ Rising Treetops

Camp Ellellbee @ Rising Treetops

Location: Philadelphia, PA | Dates: October 16-19
GENERAL INFORMATION

This section is for the person filling out the form and attending the camp. Information about other family members will be collected in the next section.
Full Name*

First NameLast Name
Nickname or Preferred Name
Pronouns
Birth Date*

MonthDayYear
CONTACT INFORMATION

This should be the main person attending the camp who we can contact with updates and questions moving forward.
Family Representative Name*
The name of the family representative who will be attending the camp
Primary / Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Primary Phone Number*
This should be a number the participant will have access to before and during the event
Preferred time for follow-up call*

Weekday MorningsWeekday AfternoonsEveningsWeekends
Preferred time zone for follow-up call*
Consent to share contact with other participants*

YesNo
Consent to receive updates from GutMonkey*

YesNo
Consent to receive messages from BioMarin^^*

YesNo
^^ Stay connected and informed! By checking the box and clicking “Yes” you're opting in to receive valuable updates about achondroplasia directly from BioMarin. This includes the latest achondroplasia news and important developments, as well as exclusive invitations to future achondroplasia community events hosted or sponsored by BioMarin. You confirm you are at least 18 years old and agree to BioMarin’s Privacy Policy and CCPA Notice and Terms of Use. You understand these communications may also contain information marketing or advertising BioMarin products, goods, or services.
Your family's primary speaking language?*
Please specify the language
Emergency Contact Name*
Please add somebody who is not attending the camp
Relationship to You*
Emergency Contact Phone*
Emergency Contact Email*
example@example.com
HEALTH INFORMATION

This section is for the person filling out the form and attending the camp. Information about other family members will be collected in the next section.
Do you have Skeletal Dysplasia?*
What type of Skeletal Dysplasia?*
Gender*
Height*
T-Shirt Size*
Does anyone in your family need assistance with mobility or getting around during the event?*

YesNo
Please list any assistive devices you use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please share any medical considerations or accommodation needs - especially those related to skeletal dysplasia - that would help us ensure your safety, comfort, and full participation in the program.*
Heart Condition, Asthma, Joint Issue, etc
Please list any health related medical conditions you live with or experience.*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, and behavioral health condition that you live with or experience.*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

Drug & Alcohol Use Acknowledgement*

I acknowledge the facility does not allow Drug & Alcohol use and will communicate any related needs.
MEDICAL INSURANCE INFORMATION
Do you have Medical Insurance?*

YesNo
Upload the photo of front of Insurance card

Cancelof
Upload the photo of back of Insurance card

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge I am financially responsible for any medical costs or prescriptions.
ADDITIONAL PARTICIPANTS
How many additional participants are you registering?*

Additional Participant 1
GENERAL INFORMATION - {fullName125}
Full Name of Additional Participant 1*

First NameLast Name
Preferred Name or Nickname (if any)
Participant’s Pronouns
Participant’s Birth Date*

MonthDayYear
Current Date (hidden)

MonthDayYear
Participant 1 Age (hidden & calculated)
Participant's Email
Since this participant is 18 or older: we’ll email this participant the legal forms to sign - Participant Agreement, Ground Conduct Agreement, and any camp‑specific docs.
HEALTH INFORMATION - {fullName125}
Does this participant have a diagnosed form of skeletal dysplasia?*
What type of Skeletal Dysplasia?*
Participant's Gender*
Participant's Height*
Participant's T-Shirt Size*
Will this participant need childcare on Saturday from 9:00 AM to 12:00 PM during the caregiver session?
Since this participant is under age 6: childcare will be available during the Saturday caregiver session. We encourage you to take advantage of this so parents can be fully present for this adult-only time.
Please list any assistive devices this participant use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please describe any medical considerations or accommodations this participant may need-especially those related to skeletal dysplasia - to help ensure their safety, comfort, and full participation in the program.*
Please list any health conditions this participant lives with or experiences.*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, or behavioral health conditions this participant lives with or experiences.*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

MEDICAL INSURANCE INFORMATION - {fullName125}
Does this participant have medical Insurance?*

YesNo
Please Upload a photo of the front of this participant's Insurance card.

Cancelof
Please Upload a photo of the back of this participant's Insurance card.

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge that this participant is financially responsible for any medical costs or prescriptions.

Additional Participant 2
GENERAL INFORMATION - {fullName155}
Full Name of Additional Participant 2*

First NameLast Name
Preferred Name or Nickname (if any)
Participant's Pronouns
Participant's Birth Date*

MonthDayYear
Current Date (hidden)

MonthDayYear
Participant 2 Age (hidden & calculated)
Participant's Email
Since this participant is 18 or older: we’ll email this participant the legal forms to sign - Participant Agreement, Ground Conduct Agreement, and any camp‑specific docs.
HEALTH INFORMATION - {fullName155}
Does this participant have a diagnosed form of Skeletal Dysplasia?*
What type of Skeletal Dysplasia?*
Participant's Gender*
Participant's Height*
Participant's T-Shirt Size*
Will this participant need childcare on Saturday from 9:00 AM to 12:00 PM during the caregiver session?
Since this participant is under age 6: childcare will be available during the Saturday caregiver session. We encourage you to take advantage of this so parents can be fully present for this adult-only time.
Please list any assistive devices this participant use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please describe any medical considerations or accommodations this participant may need-especially those related to skeletal dysplasia - to help ensure their safety, comfort, and full participation in the program.*
Please list any health conditions this participant lives with or experiences.*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, or behavioral health conditions this participant lives with or experiences.*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

MEDICAL INSURANCE INFORMATION - {fullName155}
Does this participant have medical Insurance?*

YesNo
Please Upload a photo of the front of this participant’s Insurance card

Cancelof
Please Upload a photo of the back of this participant's Insurance card.

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge that this participant is financially responsible for any medical costs or prescriptions.

Additional Participant 3
GENERAL INFORMATION - {fullName184}
Full Name of Additional Participant 3*

First NameLast Name
Preferred Name or Nickname (if any)
Participant’s Pronouns
Participant’s Birth Date*

MonthDayYear
Current Date (hidden)

MonthDayYear
Participant 3 Age (hidden & calculated)
Participant's Email
Since this participant is 18 or older: we’ll email this participant the legal forms to sign - Participant Agreement, Ground Conduct Agreement, and any camp‑specific docs.
HEALTH INFORMATION - {fullName184}
Does this participant have a diagnosed form of skeletal dysplasia?*
What type of Skeletal Dysplasia?*
Participant's Gender*
Participant's Height*
Participant's T-Shirt Size*
Will this participant need childcare on Saturday from 9:00 AM to 12:00 PM during the caregiver session?
Since this participant is under age 6: childcare will be available during the Saturday caregiver session. We encourage you to take advantage of this so parents can be fully present for this adult-only time.
Please list any assistive devices this participant use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please describe any medical considerations or accommodations this participant may need-especially those related to skeletal dysplasia - to help ensure their safety, comfort, and full participation in the program.*
Please list any health conditions this participant lives with or experiences*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, or behavioral health conditions this participant lives with or experience*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

MEDICAL INSURANCE INFORMATION - {fullName184}
Does this participant have medical insurance?*

YesNo
Please upload a photo of the front of this participant’sinsurance card.

Cancelof
Please upload a photo of the back of this participant’s insurance card.

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge that this participant is financially responsible for any medical costs or prescriptions.

Additional Participant 4
GENERAL INFORMATION - {fullName213}
Full Name of Additional Participant 4*

First NameLast Name
Preferred Name or Nickname (if any)
Participant’s Pronouns
Participant’s Birth Date*

MonthDayYear
Current Date (hidden)

MonthDayYear
Participant 4 Age (hidden & calculated)
Participant's Email
Since this participant is 18 or older: we’ll email this participant the legal forms to sign - Participant Agreement, Ground Conduct Agreement, and any camp‑specific docs.
HEALTH INFORMATION - {fullName213}
Does this participant have a diagnosed form of skeletal dysplasia?*
What type of Skeletal Dysplasia?*
Participant’s Gender*
Participant’s Height*
Participant's T-Shirt Size*
Will this participant need childcare on Saturday from 9:00 AM to 12:00 PM during the caregiver session?
Since this participant is under age 6: childcare will be available during the Saturday caregiver session. We encourage you to take advantage of this so parents can be fully present for this adult-only time.
Please list any assistive devices this participant use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please describe any medical considerations or accommodations this participant may need-especially those related to skeletal dysplasia - to help ensure their safety, comfort, and full participation in the program.*
Please list any health conditions this participant lives with or experiences.*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, or behavioral health conditions this participant lives with or experiences.*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

MEDICAL INSURANCE INFORMATION - {fullName213}
Does this participant have medical insurance?*

YesNo
Please upload a photo of the front of this participant’s insurance card.

Cancelof
Please upload a photo of the back of this participant’s insurance card.

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge that this participant is financially responsible for any medical costs or prescriptions.

Additional Participant 5
GENERAL INFORMATION - {fullName242}
Full Name of Additional Participant 5*

First NameLast Name
Preferred Name or Nickname (if any)
Participant’s Pronouns
Participant’s Birth Date*

MonthDayYear
Current Date (hidden)

MonthDayYear
Participant 5 Age (hidden & calculated)
Participant's Email
Since this participant is 18 or older: we’ll email this participant the legal forms to sign - Participant Agreement, Ground Conduct Agreement, and any camp‑specific docs.
HEALTH INFORMATION - {fullName242}
Does this participant have a diagnosed form of skeletal dysplasia?*
What type of Skeletal Dysplasia?*
Participant’s Gender*
Participant’s Height*
Participant’s T-Shirt Size*
Will this participant need childcare on Saturday from 9:00 AM to 12:00 PM during the caregiver session?
Since this participant is under age 6: childcare will be available during the Saturday caregiver session. We encourage you to take advantage of this so parents can be fully present for this adult-only time.
Please list any assistive devices this participant use, if applicable.*
Wheelchair, Crutches, Walkers, Electric Scooters, Canes, etc
Please describe any medical considerations or accommodations this participant may need-especially those related to skeletal dysplasia - to help ensure their safety, comfort and full participation in the program*
Please list any health conditions this participant lives with or experiences*
Heart Condition, Asthma, Joint Issue, etc
Please list any mental, emotional, or behavioral health conditions this participant lives with or experiences*
ASD, ADHD, etc
Dietary Accommodations
Please list any food allergies, dietary restrictions, or special meal preferences (e.g., vegetarian, gluten-free, no dairy, religious restrictions, etc.). This will help us plan safe and inclusive meals during the program.

Current Medications

	Name	Strength	Dosage	Route	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8

Allergies (Medications, Food, Environmental)

	Allergy	Reaction	Treatment	Anaphylaxis Risk	Bringing EpiPen?
Allergy 1
Allergy 2
Allergy 3
Allergy 4
Allergy 5

MEDICAL INSURANCE INFORMATION - {fullName242}
Does this participant have medical insurance?*

YesNo
Please upload a photo of the front of this participant’s insurance card.

Cancelof
Please upload a photo of the back of this participant’s insurance card.

Cancelof
Medical Responsibility Acknowledgment*

I acknowledge that this participant is financially responsible for any medical costs or prescriptions.

End of additional participants
TRAVEL INFORMATION
Please describe your travel plans
SIGNATURE & ACKNOWLEDGEMENTS
Signature*

Clear
Date*

MonthDayYear
Notes / Follow-ups
Should be Empty:

Camp Ellellbee @ Rising Treetops

GENERAL INFORMATION

CONTACT INFORMATION

HEALTH INFORMATION

MEDICAL INSURANCE INFORMATION

ADDITIONAL PARTICIPANTS

GENERAL INFORMATION - {fullName125}

HEALTH INFORMATION - {fullName125}

MEDICAL INSURANCE INFORMATION - {fullName125}

GENERAL INFORMATION - {fullName155}

HEALTH INFORMATION - {fullName155}

MEDICAL INSURANCE INFORMATION - {fullName155}

GENERAL INFORMATION - {fullName184}

HEALTH INFORMATION - {fullName184}

MEDICAL INSURANCE INFORMATION - {fullName184}

GENERAL INFORMATION - {fullName213}

HEALTH INFORMATION - {fullName213}

MEDICAL INSURANCE INFORMATION - {fullName213}

GENERAL INFORMATION - {fullName242}

HEALTH INFORMATION - {fullName242}

MEDICAL INSURANCE INFORMATION - {fullName242}

TRAVEL INFORMATION

SIGNATURE & ACKNOWLEDGEMENTS