REGISTRATION: PAGE 1

Is this the first time this athlete will attend Camp Shriver?

YesNo

Your Registration:

** Please note that the week(s) in which you choose to register for, does not guarantee a spot in Camp due to our limited capacity. **

You will receive an email with details for camp a week prior to the first day of your participation.

Listed below are the locations in which Camp Shriver is being offered. Please take a look and select which location(s) you would like to attend.

Choose your Camp Shriver location(s):

SONJ Complex DaySONJ Complex TwilightRCSJ Complex Day

SONJ Complex Day

SONJ Complex Twilight

RCSJ Complex Day

Week 1 - June 17 - June 20Week 2 - June 24 - June 27

REGISTRATION: PAGE 2

ATHLETE INFORMATION

Name

Gender

FemaleMale

Date of Birth

Age

T-shirt Size

Address

Line 2

City

State

Zip Code

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

Primary Contact Email

Enter an email that will be checked daily!

Primary Contact Phone Number

I would like to receive text alerts from Special Olympics New Jersey for any last minute Camp Shriver updates.

YesNo

Phone

Cell phone number only

EMERGENCY CONTACT INFORMATION

(if different from above)

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Athlete

REGISTRATION: PAGE 3

TRAVEL INFORMATION

How will the athlete commute to camp?

How will the athlete commute from camp?

*Please be mindful of arrival and pick-up times.

All transportation, including after-school busing and Access Link are to be coordinated between parents, case managers and the school.

REGISTRATION: PAGE 4

MEDICAL INFORMATION

Please answer the questions below with as much detail as possible.

This athlete has autism spectrum disorder.

YesNo

Check all medical conditions that apply.

Asthma	Allergies
Seizures	Blood disorder

Describe any further medical conditions of which staff should be aware.

The athlete will need to take medications listed above during Camp Shriver.

YesNo

Which medications? Please provide detailed instructions.

REGISTRATION: PAGE 6

STATEMENT OF COMPLIANCE

Camp Registration

By selecting submit, the online registration portion for Camp Shriver participation is complete.

By signing below, you understand and agree to the above.

First Name

Last Name

Does not like loud noises	Does not like whistles
Exhibits self-stimulatory behavior	Needs bathroom reminders
Easily upset or cries often	Hyperactive
Runs away often	Does not like bright lights
Visually impaired	NOT toilet trained
Needs constant redirection	Resistant to change or transitions
Obsessive compulsive	Tendency towards extreme anger
Exhibits aggressive physical behavior

ATHLETE INFORMATION

PARENT/GUARDIAN INFORMATION

TRAVEL INFORMATION

MEDICAL INFORMATION

BEHAVIORAL INFORMATION

STATEMENT OF COMPLIANCE