2026 ANNUAL REGISTRATION CSF Athlete/Participant Profile

Camp PossAbilities is a 90-minute recreational, therapeutic, adaptive, and inclusive program created by the Christina Sullivan Foundation, providing individuals of varying abilities the opportunity to participate in a multitude of activities centered on physical activity, nutrition, and inclusion. The program is fostered through partnerships with medical and educational institutions to promote community engagement, education, and collaboration. All programs are adapted to skill level. All equipment is provided.

Buddy volunteers are partnered with our athletes/participants with differing abilities to enhance the experience of providing opportunities to create bonds of trust. This leads to inclusion empathy and compassion the Mission of the Christina Sullivan Foundation.

It's not about the sport. It's so much more. Josephine Sullivan, FOUNDER & CEO

Theraputic Benefits

- Stress Reliever - Builds Self Esteem - Creates Social Bonds - Exercise leads to a healthier lifestyle.

All equipment and supplies are provided.

HIPAA (Protected Medical Privacy Rule)

CHRISTINA SULLIVAN FOUNDATION - PROGRAM AGREEMENT

The Christina Sullivan Foundation

Program Guidelines

At The Christina Sullivan Foundation, we aim to create meaningful, adaptive, and inclusive experiences for every athlete and participant. To ensure smooth operations and equal access for all, please review the following guidelines before registering your child for the Christina Sullivan Foundation.

1. Annual Registration Requirements

To take part in any Christina Sullivan Foundation program, families must complete the following once each calendar year.

A. Annual CSF Registration Donation – $35

This annual donation helps fund administrative expenses, insurance needs, and program growth.

The yearly $35 CSF registration fee covers:

• One Camp PossAbilities practice shirt for the year

• One Camp PossAbilities athlete/participant ID card for the year

If an athlete or participant ID card is lost or misplaced, a $5 donation will be required for a replacement.

B. Annual CSF JotForm Registration

Families must complete the Annual CSF Registration JotForm for the athlete/participant. This form updates emergency contacts, medical information, release agreements, and communication permissions.

C. Annual SOTX Athlete/participant Registration Form

All athletes and participants must complete and submit the Special Olympics Texas (SOTX) annual registration and medical form.

• This form must be sent directly to SOTX.

• A current and valid SOTX registration is necessary to participate in all CSF activities.

English:

https://www.sotx.org/files/ misc/athlete+registration+ form+english+as+4.7.2025.pdf

Spanish:

https://www.sotx.org/files/ misc/athlete+registration+ form+spanish+as+4.7.2025.pdf

These items ensure athlete/participant safety and compliance with partnering organizations.

2. Attendance Commitment

Camp and program spaces are limited and often fill quickly. When you register your athlete/participant, you are reserving a space that could otherwise go to a child on the waiting list.

We understand that sometimes life is beyond our control. Illnesses, unexpected emergencies, and family matters occur. If your athlete or participant has to miss a practice or camp session due to circumstances outside your control, you must notify CSF immediately.

• If you know in advance that your athlete or participant cannot attend, please inform us at least 7 days before the program begins.

• Repeated no-shows without communication may affect eligibility for future programs.

3. Communication

We require all parents and guardians to:

• Download the GroupMe app, and

• Join the official Camp PossAbilities GroupMe channel for the program(s) in which their athlete or participant is registered.

All Camp PossAbilities program communication—including reminders, updates, schedule changes, and urgent notices—will be sent through GroupMe.

If an illness, emergency, or other unexpected situation prevents your athlete or participant from attending, please notify us immediately via GroupMe or direct contact.

4. Participant Readiness

Parents/guardians are responsible for ensuring that:

• Their athlete/participant arrives prepared and able to safely participate

• Required medical or support equipment is provided

• All medical, behavioral, or safety concerns are communicated in advance

5. Respect and Inclusion

Camp PossAbilities is founded on kindness, acceptance, teamwork, and belonging.

6. Program Changes or Cancellations

If a camp or program must be changed or canceled, families will be notified through GroupMe immediately.

Acknowledgment

By registering for Camp PossAbilities, you acknowledge that you understand and agree to all guidelines listed above.

Signature

- Please upload a clear picture of athlete/participant. *

Please Upload a picture of you and or your athlete/participant TOGETHER. This will assist staff and buddy volunteers identify families/caregivers.*

Athlete/Participants First and Last Name*

First NameLast Name

Athlete/Participants Age*

Athlete/Participants Date of Birth*

Date

Grade/Graduated*

Relevant Diagnosis: Ex. Down Syndrome, TBI, dyspraxia, hemiplegia, Autism Spectrum Disorder (ASD), etc. *

The health information that you provide is under the protection of the federal Health Insurance Portability and Accountability Act (HIPAA). We can use your health information for purposes of treatment, payment and health care operations. Under HIPAA, you have the right to Request restrictions on how we use or disclose your health information in certain circumstances, including for treatment, payment or health care operations. We do not have to agree to your request unless you request restriction on disclosures to a health plan for purposes of payment or healthcare operations, and the health information relates to an item or service for which you, or another person on your behalf, have assumed full financial responsibility. If we do agree to your restrictions, we will be bound by our agreement except in limited circumstances, such as if there is an emergency.

Allergies:*

Parent/Guardian/Caregiver First and Last Name *

First NameLast Name

Parent Cell Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Parent Email Address*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Vision Statement: Ex:(What would you like to see your athlete achieve in the future?) Independence, sociability, following instructions, healthy eating choices, and exercise more...*

What works well for my athlete: Example, multi-step instruction, hands-on support, verbal instruction, positive reinforcement, peer modeling, etc *

.

What does not work well for my athlete /participant? (Example, multi-step instructions, negativity. Yelling/loud voice, hand on instruction, etc*

.

Tell us your athlete/participant's hobbies/interests: Ex. Youtube, Disney Movies, singing, gardening, sewing, reading comic books, drawing, tennis, walking, swimming, etc.*

.

What is the best way to address your athlete/participant, and how do they prefer to communicate? Ex. First name, a nickname, ASL, verbal, etc*

.

My athlete/participant strengths Include: *

Tell us about your Athlete's movement and mobility: *

Ex. ambulates (walks) independently, walks slowly, occasionally has issues with balance, individual uses a self-propelled wheelchair, individual uses a power wheelchair, etc.

Tell us what your athlete/participant is working on: *

For example, social skills, attention to play in a group, increasing physical activity, learning a new sport, making new friends, strength, endurance, etc.

Participant Name*

First NameLast Name

Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian/Caregiver Phone Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Participants Medicare/Medicaid #*

Waiver Program: Community Living Assistance and Support Service (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCBS), Medically Dependent Children Program (MDCP), STAR+PLUS Home and Community-based Services (HCBS), Texas Home Living (TxHmL) and Youth Empowerment Services (YES).

Insurance Company:*

Name of Policy Holder:*

Policy Number:*

Insurance Company Phone Number:*

Please enter a valid phone number.Format: (000) 000-0000.

Are you receiving Recreational/OT/PT Speech/Therapy Services*

Physicians Name:*

Physicians Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Physicians Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Camp PossAbilities Scholarship Application

We want all of our participants to have the opportunity to experience Camp PossAbilities. If necessary, the Christina Sullivan Foundation will offer financial scholarships. Once you've finished this form, we'll reach out to you for more information. You'll need to provide all information on the Intake to receive an application.

WAIVER & RELEASE

CONSENT

As the parent or guardian of the child/ren named above, I consent to my child/ren’s participation in The Christina Sullivan Foundation. I understand that The Christina Sullivan Foundation are program activities, and I agree that I (or another responsible adult whom I approve) will assist and supervise my child/ren. I understand that the organizers of The Christina Sullivan Foundation are not and will not be responsible for supervising my child/ren.

RELEASE AND INDEMNITY

I hereby release, discharge, and covenant not to sue The Christina Sullivan Foundation, the organizers of The Christina Sullivan Foundation, and their directors, officers, employees, agents, volunteers, representatives, owners, members, affiliates, successors, assigns and anyone associated with The Christina Sullivan Foundation (collectively, 'Released Parties'), from all liability to me, my child/ren, my and my child/ren’s personal representatives, assigns, heirs and next of kin, for any and all claims, demands, actions, complaints, suits, losses or damages on account of any injury to me or my child/ren, or in connection with my child/ren’s participation in The Christina Sullivan Foundation, including but not limited to personal injuries or property damage caused or alleged to be caused, in whole or in part, by the negligence of the Released Parties or otherwise.

If, despite this release, I, my child/ren, or my child/ren’s personal representatives, assigns, heirs or next of kin make a claim against any of the Released Parties named above, I agree to indemnify, defend and hold harmless the Released Parties from any litigation expenses, attorney fees, loss, liability, damage, or cost incurred due to such claim.

Furthermore, I agree to release, indemnify, defend and hold harmless the Released Parties from and against any and all claims, demands, actions, complaints, suits, losses, damages or other forms of liability that any of them may sustain arising out of my child/ren’s failure to comply with applicable laws or arising out of any damage or injury caused by me or my child/ren in connection with participation in The Christina Sullivan Foundation.

I HAVE READ THIS PARENTAL CONSENT, UNDERSTAND THAT BY AGREEING I GIVE UP SUBSTANTIAL RIGHTS THAT I AND/OR MY CHILD/REN WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASED PARTIES’ FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT. I ALSO CONFIRM THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD/REN NAMED ABOVE.

PHOTOGRAPHY DISCLAIMER

I hereby grant The Christina Sullivan Foundation permission to make still photographs, video recordings, audio recordings and other recordings of me and/or my child/ren and/or to use my name and/or my child/ren’s name and/or my likeness and/or my child/ren’s likeness and/or verbal quotes from me and/or my child/ren (“Authorized Materials”) and to reproduce and distribute the Authorized Materials in or across any media. I also give The Christina Sullivan Foundation permission to use the completed Authorized Materials, and to use my or my child/ren’s name and likeness for The Christina Sullivan Foundation promotional and commercial purposes without compensation. I waive the right to review materials produced by The Christina Sullivan Foundation, including those using my or my child/ren’s name and likeness.

Furthermore, I relinquish and grant to The Christina Sullivan Foundation all rights, title and interest in and to the Authorized Materials that I and/or my child/ren may have, including but not limited to completed still photographs, video tapes, audio recordings, negatives, prints, reproductions, duplicates and verbal quotes for print. I will not object to or take any adverse action against The Christina Sullivan Foundation for use, reproduction, or distribution of such Authorized Materials.

Signature

Athlete/Participant Shirt Size

To review Christina Sullivan Foundation Camp PossAbilities programs and activities

click: Camp PossAbilities Programs

My Products

Annual Registration Donation 2026

$35.00 Quantity
Item subtotal:$0.00

Total

$0.00

Welcome to Camp PossAbilities!

CAMP POSSABILITIES ANNUAL REGISTRATION 2026 Complete the Jotform

Information Athlete/Participant Profile

Parent/Guardian/Caregiver Information

ATHLETE/PARTICIPANT Medical Profile

Athletes/Participants Information