TO GUARANTEE CAMP REGISTRATION
Please follow the guidelines regarding registration forms listed below. Summer Camp Registrations for 2009 are being accepted on a first come/first served basis February 6th through April 17th, 2009.
Please Note: Camp Registration forms are in Adobe PDF format. Each link will open a file in PDF format and can be opened using the free Adobe Acrobat Reader, which can be downloaded at http://www.adobe.com/acrobat.
Please take time to fill out the Ability, Behavioral and Other additional information sections on this form. Accurate and detailed information about the applicant helps us provide them with a comfortable and enjoyable camp experience. Be sure to include cell phone information and one or more emergency contact numbers. Check the appropriate clinical diagnosis provided or list the disability in clinical terms next to the box marked other. Medication information should be accurate according to the date of the specific camp week. The photo release allows us to use the applicant's picture in brochures and presentations concerning camp activities.
Financial Information (pages 4 & 5) must be completed as Easter Seals Nebraska's mission to continue providing a camp program for current and future generations means the financial interests of the program must be protected. Applications will be returned if financial information is not complete. There are three ways camp fees can be paid:
Private Pay: where the applicant or caregiver is paying the camp fee. Please include the name and contact information of the person financially responsible.
Outside Funding: where an organization or private party is paying the applicant's camp fee. Please include the name of the organization, contact person, address, zip code and phone number.
Government or State Waivers: where applicant is eligible for financial aid to cover all or a portion of the camp fee. The current type of waiver received by the applicant must be indicated by checking the appropriate box. Please fill out the authorization number, ID number, case number, service code, service coordinator, address and phone number completely. Contact your service coordinator to provide you with this information.
Partial Scholarships (page 5) are provided based on financial need, and are limited. If you would like a Campership Information 2009, please download one online or call the Easter Seals Nebraska office (402) 345-2200, and one will be mailed to you.
Registration Fee: A $250 non-refundable registration fee must be included with the participant application or the application will be returned. The registration fee is separate from the camp fee and is non-refundable however if the entire camp fee is paid when turning in the application then the registration fee is only $150.
Autism Camp Questionnaire
Easter Seals Nebraska is very pleased to be offering camps specially designed to meet the unique needs of individuals with Autism Spectrum Disorder. Families of campers with autistic tendencies need to please fill out the Autism Camp Questionnaire.
Physician’s Summary Form
This form must be completed and signed by the participant's licensed physician and returned as soon as possible. While it does not necessarily need to accompany the initial camper application form, we do need to have it no later than three weeks prior to camp arrival date. These forms will be returned if not properly signed by the physician and including the physician’s contact information.
Liability, Health & Activity Release Form
Please fill out completely. Signatures are required on all lines as requested.
Medication Guidelines & Release Form
Please fill out completely. Signatures are required on all lines as requested
Please contact us if you have any questions regarding these guidelines. We look forward to seeing you at camp!
Mike Tufte, Camp, Respite and Recreation Director
(402) 345-2200 ext 1112
mtufte@ne.easterseals.com
If you live in Douglas or Sarpy County and need financial assistance for camp or respite programs, click here.
