2025 Rainbow Day Camp Registration 2025 Rainbow Day Camp "*" indicates required fields YOUTH PARTICIPATE INFORMATION:Camper's Preferred First Name*Last Name*Birth Date (mm/dd/yyyy)* MM slash DD slash YYYY Bus Transportation Needed Yes No Dropping off and picking up Yes No Please select t-shirt size:* Youth Small Youth Medium Youth Large Youth X-Large Adult Small Adult Medium Adult Large Adult X-Large Student's School*Grade completed Spring 2025*Teacher of the Visually Impaired (TVI) or O&M Specialist First Last TVI / O&M PhoneTVI / O&M Email Age when vision impairment was first diagnosed:Diagnosis or cause of vision impairment (if known):Visual acuity and field of vision:Please list all medical restrictions (including seizures) that require special modification with physical activity, including risk of retinal detachment:Will your child(ren) need emergency medication or rescue? (epi-pen, inhaler, seizure, etc.) If yes, please list in medications section.* No Yes Medical Consent:* I agree to my child receiving medical assistance from a staff member or trained volunteer, if needed. List all medications student is currently taking including all emergency medications: (Camp staff will not be responsible regarding administering or reminding youth to take any medications)List any allergies and dietary restrictions:YOUTH INTERESTS AND SKILL LEVELS:Describe youth's current sports participation at school, clubs, recreation, etc. (No experience is necessary):What goals would your child like to achieve at this camp?How does your child feel about attending camp this year?Describe any behavioral issues your child has had at school, and the best strategies for addressing them.PARENT/GUARDIAN INFORMATION:Please list information for parent/guardian with whom the athlete currently resides.Parent First and Last Name*Relationship to youth:*Preferred Phone:*Email:* Preferred address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Consent to Participate:* I understand there is risk of injury in any sport activity and grant permission for participation. Days Attending Camp* Monday Tuesday Wednesday Thursday Photographic Release I grant permission to use photographs and video taken of my minor child at the Rainbow Day Camp. Parent/Guardian Signature:*Date MM slash DD slash YYYY Names of all individuals who have permission to pick-up youth at camp.EMERGENCY CONTACT:If parent/guardian cannot be reached, in case of emergency, contact:1st Contact Name:* First Last Relationship to youth:*Preferred Phone Number:*2nd Contact Name:* First Last Preferred Phone Number:*Code of Conduct: Please review the following with your child(ren) who are participating in camp. In accordance with JCC Camp Policy…* I am willing to participate in camp activities. I will keep my hands to myself and will not physically touch other campers without their permission. I am able to communicate my needs (If unable, I will be accompanied by a parent/guardian). I will show respect to all staff members and volunteers. I will not wander or leave my group. I will eat while at camp, to stay nourished and healthy. I will be non-violent and will not be physically aggressive toward others. Consent:* I have reviewed this information with my child(ren). My child understands and agrees to these terms.