Register

Camper's Name *

First

Last

Email *

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Address *

Phone *

Age *

Birthdate *

month/day/year

Sex *

Male
Female
Prefer not to answer

Grade *

School Attending *

Does camper attend special education classes? *

Yes
No

Primary Disability *

Secondary Disability *

Please indicate the type of equipment your child will have at camp *

Manual wheelchair
Power wheelchair
Other

Specific Shirt Size *

MEDIA RELEASE: Colorado Junior Wheelchair Sports Camp (CJWSC) uses photographs, slides, videos, or illustrations of campers for many purposes related to CJWSC business. This form allows you to grant or deny permission to CJWSC to release your child’s image for display or publication. This form also allows a parent or guardian to choose whether or not their child may be identified by name on the CJWSC website. Camper's names may be released unless a parent or guardian has expressly contacted the camp and requested their child’s “information” not be shared. However, as a safeguard, the CJWSC does not directly publish campers names to the Internet unless given permission by a parent or guardian. *

I grant permission for use of my child’s image in print, video and/or digital media. I understand that my child’s image may be used or released by CJWSC without additional notification and that my child’s name may appear along with his or her photograph
I deny permission to use my child’s image for display, publication or release to external organizations.