Emmaus Summer Camp 2026 Registration

Emmaus Summer Camp 2026 Registration

Welcome to our 2026 summer camp for friends with special needs!
Who is filling out this form? (Parent or Guardian) Please tell us.
Name of person filling out this form (if not the participant)

First NameLast Name
Relationship to participant
Phone number of person filling out this form (if not the participant)
Please enter a valid phone number.Format: (000) 000-0000.
Participant's Full Name*

First NameLast Name
Who is your leader / area?*
Please specify your leader's name or write 'none' if Other selected*
Participant's Gender*
Date of Birth (Must be 18 or older)*

MonthDayYear
Date
Email Address*
This is the email address that will receive your registration confirmation.
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Please tell us about any disability or accessibility needs*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any health conditions we should know about?
Do you have any dietary restrictions or food allergies?
Do you have any medical conditions we should be aware of?
Does the camper have any behavioral issues we should know about?
Is the camper sensitive to noise?
Does the camper have any sleeping issues or behaviors during the night?
Are there any activities or games that are not suitable for the camper?
Additional Comments or Requests
YesNo
Camp T-Shirt Size*
Medication Information & Authorization

Please provide detailed information about any medications your participant will be taking during camp, including dosage and administration times. This information is essential for the safety and well-being of all participants. Fill out the Medication Details table below accordingly.
Medication Details
Parent/Guardian Contact Information
Parent/Guardian Full Name

First NameLast Name
Relationship to Participant
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Yes
Waiver and Release of Liability*
By signing this waiver, I release the Summer Camp 2026 organizers from any injury, loss, or damage during camp activities. I understand the risks and accept responsibility. I also consent to emergency medical treatment if needed.
Please note: The registration fee is non-refundable. It covers all bookings and expenses. Good news! Many families receive Regional Center reimbursement — ask your case manager for details. Feel free to email camps@emmausinn.org if you need help with the reimbursement process and information.

My Products*

Summer Camp 2026 Fee

Registration fee for Summer Camp 2026

$750.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Emmaus Summer Camp 2026 Registration

Who is filling out this form? (Parent or Guardian) Please tell us.

Medication Information & Authorization

Parent/Guardian Contact Information