Register

Easterseals Virtual Camp Registration

Join us monthly throughout 2022

We're so glad you're joining us for Easterseals Virtual Camp! We look forward to connecting with our campers and bringing the best parts of camp directly to you through our online camp experience. Please complete the required fields below, and email us with any questions!

If you have an existing account, please log in here to prepopulate your information.

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What is your relationship to the camper?

Parent / Guardian Details

Field Is Required First Name

Field Is Required Last Name

Street Address 1

Street Address 2

City

State / Province

Field Is Required ZIP / Postal Code

Field Is Required Email Address

Field Is Required Phone Number

You'll receive important camp updates and periodic communications about our work. You can unsubscribe at any time.

Keep me logged in. What's this?

Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

Field Is Required User Name 5 to 60 characters

Field Is Required Password 5 to 99 characters

Field Is Required Repeat Password

Camper Details

Choose Your Cabin Mascot

Camper 1

First Name

Last Name

Birthday

Camper 2

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 3

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 4

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 5

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 6

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 7

Field Is Required First Name

Field Is Required Last Name

Birthday

Camper 8

Field Is Required First Name

Field Is Required Last Name

Birthday

Add Another Camper

Consent Form Easterseals Virtual Camp

With the understanding that Easterseals, Inc. will make every reasonable effort to prevent accidents, injuries, or other mishaps, I acknowledge the following:

The undersigned agrees to indemnify and hold harmless Easterseals Inc. Virtual Camp for any and all claims, demands, costs, expenses, including reasonable attorney’s fees that Easterseals Inc. may suffer as a result of any claim, action, demand or judgment against it arising from the attendance at camp by the applicant. Provided, however, that the above and foregoing shall not be construed to indemnify the Easterseals Inc. from any act of negligence or fault on the part of Easterseals Inc., its officers, agents or employees.

The undersigned does consent that photographs, video or motion pictures may be taken of the named applicant during the camp period, and said photographs, video or motion pictures may be published in newspapers, magazines, television, web site, publicity releases and/or other media.

The undersigned does hereby agree to allow participation of applicant in all camp activities (except those restricted).

The undersigned recognizes the right of the Camp Director, in his/her absolute discretion, to remove a camper from the virtual platform at any time due to disciplinary or medical actions that might jeopardize the camper’s or others’ health and safety at camp. The undersigned agrees not to send the applicant to Easterseals Inc. camp if he or she has been exposed to a contagious disease within three (3) weeks of the starting date of camp, and to notify the Camp Director if this situation arises.

The undersigned recognizes that it is their obligation to notify Easterseals Inc. of any other persons, other than parent or guardian, in the location, either on or off camera and who can hear or see the session. I understand that I am responsible to ensure privacy at my location. I will notify Easterseals at the outset of each session of any exceptions and am aware that confidential information may be discussed.

The undersigned recognizes that it is their obligation to ensure that any virtual assistant artificial intelligence devices, including but not limited to Alexa or Echo, will be disabled or will not be in the location where information can be heard.

The undersigned agrees to not record either through audio or video any of the session unless I notify Easterseals and this is agreed upon.

I understand there are potential risks to using virtual technology, including but not limited to, interruptions, unauthorized access, and technical difficulties. I understand some of these technological challenges include issues with software, hardware, and internet connection which may result in interruption.

I understand that Easterseals is not responsible for any technological problems of which Easterseals has no control over. I further understand that Easterseals does not guarantee that technology will be available or work as expected.

I understand that I am responsible for information security on my device, including but not limited to, computer, tablet, or phone, and in my own location.

I understand that the use or presence of weapons, drugs, tobacco and alcohol are not allowed at Easterseals Virtual Camp.

I understand that Easterseals will not be providing supervision for campers, that supervision must be provided by me or another caretaker.

Field Is Required Acknowledge consent

I have read and understand the information provided above regarding virtual camp and my (my child’s) participation in the virtual format. I hereby acknowledge and consent to the terms, conditions and disclaimers listed in this Consent Form.