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Home / Programs & Services / Camp & Respite Services / Veterans Family Camp Application

Veterans Family Camp Application

Which weekend(s) will you attend?(Required)
Do you prefer a private room?
Name
Gender
Address
What is your preferred method of receiving notifications and paperwork?
This information is used for statistical purposes only.
How did you learn about the Veterans Family Camp?

If you have not received COVID vaccination, educational information can be accessed at https://www.cdc.gov/vaccines/covid-19/hcp/index.html
Emergency Name #1 (If there is an emergency at camp, please list who to notify):
Emergency Name #2
Emergency Name #3
Do you require any personal care assistance outside of what your family or caregiver can provide during the session?
Indicate all that apply to camper:
Uses wheelchair?
When?
Name/Family Member #1 - Please list all family members that plan to attend with you.*
Address
Gender
Mobility comments
Name/Family Member #2
Address
Gender
Mobility comments
Name/Family Member #3
Address
Gender
Mobility comments
Name/Family Member #4
Address
Gender
Mobility comments
*If you have more than four family members attending, please email veterans@eastersealswisconsin.com to send additional attendee information.
Liability & Field Trip Release(Required)
I hereby give my consent to attend Easterseals Wisconsin Camps, located in Wisconsin Dells, Wisconsin, and give permission to go with the Easterseals Wisconsin camp staff on field trips during the 2020-2021 camp sessions. In consideration for the acceptance for myself and family members I hereby release and waive any claim or cause of action which may occur against Easterseals Wisconsin and employees or any other person acting with permission arising out of any injury to his/her person or property during his/her stay at the session, in transit to and from said session, or during any activity approved by and of said persons for injury as herein stated. I have read the foregoing release and authorization before affixing my signature below, and warrant that I fully understand the contents thereof.
Media Release (optional consent)
Be in narratives, film, photographs, videotape or sound recordings made by Easterseals Wisconsin that may be used by Easterseals Wisconsin, and those acting with its permission, for the purpose of illustrations or broadcast in connection with the work of Easterseals Wisconsin. I understand that use of the aforementioned media may include publication on Easterseals Wisconsin internet site, www.EastersealsWisconsin.com. To ensure my child’s or my privacy, Easterseals Wisconsin will use only veteran/family member’s first name and the location of the Easterseals Wisconsin organization where services were received.
Photo Release (optional consent)
Have photos taken by camp staff for personal use only I have read the foregoing release and authorization before affixing my signature below, and warrant that I fully understand the contents thereof.
National Sex Offender Background Check(Required)
Easterseals Wisconsin will run a National Sex Offender (NSOPW) Background Check on all participants 18 years or older attending in the Veterans Family Camp session. Please list all legal names of individuals 18 years or older in the space below. Approval of registration for each participant is contingent upon successful completion of a NSPOW check. Positive convictions within the database may disqualify a participant from attending the camp program. Participants my request a copy of their NSOPW check at any time.
Please describe fears, likes, dislikes, or habits that you feel would be helpful for the staff to know. Please provide any suggestions, about you or your family members, you may have for a great weekend at camp.
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Easterseals Wisconsin

Easterseals Wisconsin is a 501(c)(3) nonprofit organization

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1468 N. High Point Rd., Ste. 202
Middleton, WI 53562

800.422.2324 (toll-free)
608.277.8288 (voice)
608.277.8333 (fax)
608.277.8031 (tty)

info@eastersealswisconsin.com

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