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Registration Form – Summer Camp

Rainbow Day Camp

For students ages 5-18 with vision loss
July 19 – July 22, 2021
8:30 am – 4:30 pm at The Albert & Ann Deschur JCC Camp in Fredonia
Cost: $40 per person
Register by Monday, June 28, 2021

*Youth must have a medically diagnosed visual impairment and be independent in areas of walking, dressing, toileting and eating to participate in this camp.

  • YOUTH PARTICIPATE INFORMATION:

  • MM slash DD slash YYYY
  • YOUTH INTERESTS AND SKILL LEVELS:

  • No experience is necessary.
  • PARENT/GUARDIAN INFORMATION:

    Please list information for parent/guardian with whom the athlete currently resides with.
  • MM slash DD slash YYYY
  • EMERGENCY CONTACT:

    If parent/guardian cannot be reached, in case of emergency, contact:

The cost for camp is $40 per youth.  Contact Emily Zajork, 414-615-0179 or , to make your payment directly, or you will receive a link with your registration confirmation to make an online payment.