2026 Buddy Camp Registration Form

Registration Form
Name of Program:

2026 WNCDSA Buddy Camp

Dates: July 6-10, 2026

Time: 9am - 3pm

Location: Lutheridge - 2049 Upper Laurel Dr, Arden, NC

WNC Down Syndrome Alliance is paying registration costs

Questions? Problems filling out this form?

Email us: wncdsa@gmail.com
Participant Name (Full Name)*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Grade
Current-in or Just Completed
Parent/Guardian Name (Full Name)*

First NameLast Name
Relation*
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name (Full Name)*

First NameLast Name
Relation*
Date of Birth*

MonthDayYear
Date
Email Address
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Name
Church Location
Name
Relation
Phone Number
Name
Relation
Phone Number
Health Insurance Information

NovusWay Inc. has secondary accident insurance. The parent/legal guardian is responsible for all charges associated with an accident or illness.
Carrier Name
Carrier Address
Policy #
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Policy Holder's Name*

First NameLast Name
Policy Holder's Date of Birth*

MonthDayYear
Date
Bin#
(If you have)
ID#
(If you have)
Group#
(If you have)
Doctor's Name*
Doctor's Contact info*
Recommendations/Restrictions at Camp (Please describe in Detail)
NoYes
NoYes
How does the camper feel about camp/what fears does the camper have?
What camp activities do you think the camper will enjoy the most?
How does the camper communicate?
Does the camper have any behaviors we need to know about?
How much assistance does the camper need for toileting, hygiene and changing into a bathing suit?
T-Shirt Size*
Dietary Need/Food Allergies
Other Concerns (Mobility, Behavior, etc.)
YesNo
YesNo
PERMISSION TO TREAT:

The Person this registration is for has permission to engage in all camp activities except as noted. I hereby give my permission to NovusWay Ministries to provide routine health care, administer prescribed medications and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission for the camp to arrange necessary, related transportation for me/my child. In the event that I or the emergency contact cannot be reached in an emergency I hereby give permission to the Health Care Provider selected by the camp to secure and administer treatment, including hospitalization, for the person named in this form. This completed registration form may be printed/copied for trips off camp.
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
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Registration Form

Health Insurance Information