Summer Camp Registration - Variety Kids St. Louis

Register for Summer Adventure Camp 2022

Sign up now for Summer Adventure Camp 2022! This free day camp experience is just for kids and teens with disabilities living in the 30 Missouri and Illinois counties Variety St. Louis serves.

Adventure Camp is available to children and teens ages 4 – 20. Campers are split into groups based on age, and activities are geared towards each age group. These activities may include swimming, ice skating, fishing, playing games, making crafts, music time, visiting area attractions and much more, all under the guidance of a caring and enthusiastic staff.

This year’s Camp schedule is below – all ages are invited to attend each week. The location of camp changes weekly or daily to accommodate different activities and adventures, but each is located within the St. Louis region.

Summer Camp 2022 Schedule:

Week 1: June 6 – 10, 2022
Week 2: June 13 – 17, 2022
Week 3: June 20 – 24, 2022
Week 4: July 11 – 15, 2022
Week 5: July 18 – 22, 2022
Week 6: July 25 – 29, 2022

Note that Summer Camp 2022 is currently being planned as an in-person Camp. If necessary to keep our campers safe and healthy due to the pandemic, it is possible that we will switch to a Virtual Camp program – you may let us know in the registration form whether your child would be interested in a Virtual Camp if this need arises.

Register using the form below by noon on Monday, February 7 and be sure to select your preferred weeks. Questions? Contact Robin Diehl at Robin@VarietySTL.org.

See you this summer!

Register Now for Summer Camp 2022

*Required field

Variety has every intention of holding Summmer Camp in person if conditions are safe to do so.

If conditions are SAFE and camp will be in person, I would like to register my child for in person camp.(Required)

Yes

If conditions are NOT safe and in person camp is not being held, I would like to register my child for virtual camp.(Required)

Yes

Preferred number of weeks to attend camp(Required)

My first choice is(Required)

My second choice is(Required)

My third choice is(Required)

Camper Information

Camper Name

First Last

Camper Date of Birth(Required)

T-Shirt Size

My child identifies as(Required)

What is your child's race/ethnicity?(Required)

Is this your child's first time at Variety Camp?(Required)

Yes

Primary Diagnosis(Required)

Secondary Diagnosis

Parent/Guardian Information

Parent/Guardian Relationship Type

Parent/Guardian Name

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

County(Required)

Primary Phone(Required)

Secondary Phone

Email(Required)

Do you need to add information for an additional parent?(Required)

Yes

Parent/Guardian 2 Relationship Type

Parent/Guardian 2 Name

First Last

Address 2

Same as previous

Street Address City State / Province / Region ZIP / Postal Code

County

Primary Phone

Secondary Phone

Additional Health Information

Child's Medical History(Required)

Enter any additional health related information that will assist camp staff in helping your child have a successful camp experience.

What are your child's communication abilities?(Required)

My child speaks and is understood by others

My child is able to maintain a two-way conversation

My child communicates through Sign Language

My child communicates through an Augmentative Speech Device

My child communicates through their iPad

My child communicates through gestures

My child is nonverbal or has limited conversational abilities

My child has no means of communication

List any allergies your child has.(Required)

(i.e., peanuts, bee stings, latex)

Please provide tips to communicate with your child.(Required)

(i.e., peanuts, bee stings, latex)

My child eats...

Independently

Hand-over-hand assistance

Tube Fed

Only small soft foods

Pured foods

(check all that apply)

Toileting needs:(Required)

Tricks for happy toileting experiences:

(i.e. how you get your child to lay down, or sit on the toilet, frequency of bathroom breaks, etc.)

Preferences

Preferred Counselor

Preferred Friend

If you wish your child to be paired with a certain child we will try to accommodate your request. This is to enhance socialization. Both friends must choose one another.

General Information

School or program your child attends(Required)

School District(Required)

Does your child have a behavior plan in place at school?(Required)

Yes

Having a behavior plan in no way disqualifies any child from participation in Variety Camp. If your child does have a behavior plan, please fax or mail a copy to Variety. Feel free to provide details or alter procedures for camp setting. Please share this plan with your child’s counselor.

Does your child have any "triggers" - event or situation that precedes an inappropriate response to a situation?(Required)

Yes

If your child does have triggers, please explain.

Describe the best way to encourage your child to follow directions.(Required)

How well does your child follow directions in a group setting?

My child understands and follows directions consistently

My child rarely follows directions unless extra incentive is provided

My child does not understand or follow directions

What is the best way to motivate your child?(Required)

List any strong fears your child has.(Required)

What activities does your child particularly like?(Required)

What activities does your child particularly dislike?(Required)

What are your expectations for your child while they participate in Variety Camp?(Required)

Enter any other information you feel would be beneficial to Camp staff.(Required)

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

I am the ward or guardian of above camper, (“the child”). I am responsible for the child and have authority to sign this release on behalf of the child. Variety the Children’s Charity of St. Louis (“Variety the Children’s Charity of St. Louis”), is sponsoring 2022 SUMMER ADVENTURE AND TEEN CAMP.

Either the child by him or herself, I by myself, or the child and I together wish to participate in the event. There is no charge to us for our participation.

I understand that unless I sign this release, including all its terms, on behalf of the child and me, the Variety the Children’s Charity of St. Louis will not allow the child or me to participate in the event.

In order to participate in the event, on behalf of the child and myself, I therefore release the officers, directors, agents, affiliates, sponsors, volunteers, successors, assigns and employees of Variety the Children’s Charity of St. Louis from all liability for injuries or damages resulting from activities connected with the event, to the extent those injuries or damages are result of negligent acts.

I further agree to hold the released parties harmless and to indemnify them against any claims brought against them by third parties due to my actions and/or the child’s actions.

On behalf of the child and myself, I thus hereby release the released parties from all claims for damages or injuries for negligent acts connected with the event. I exclude from the release grossly negligent acts, intentional acts, and acts done with malfeasance.

I understand this release is quite broad, but I nevertheless accept its terms.

I acknowledge and agree to the Release, Indemnification, and Hold Harmless Agreement.(Required)

Yes

Media Release

I hereby authorize the media and/or representatives of the Variety the Children’s Charity of St. Louis to take photographs and/or videos of the child and me, and to publish and/or air those photographs and/or videos for the purposes of publicity and/or other reasonable purposes.

I acknowledge and agree with the Media and Photo Release.(Required)

Yes

Note: Declining the Photo and Media Release does not make your child ineligible to participate in Camp.

Variety Camp Behavior Policy

The mission of Variety Camp is to provide a supportive environment where children with physical and developmental disabilities can improve their skills and self-esteem, leading to greater socialization and independence.

Variety wants your camper to have a successful camp experience. We feel that all campers, staff, and volunteers should feel safe and comfortable in our program.

Variety staff will contact you if your child is having a difficult time participating in activities appropriately. Specific follow-up plans will be put in place following a parent-staff discussion.

If the camper’s difficulties are not able to be successfully addressed, Variety Camp reserves the right to dismiss your child if he or she exhibits inappropriate behavior or is not having a successful recreational experience. Dismissal is done at the discretion of the Camp Manager.

If your child has an IEP, 504 Plan, or any other behavior plan in place during the school year which would be beneficial at camp, send this in with your application. Please only send portions that you feel would relate to the camp experience to robin@varietystl.org.

I acknowledge the importance of the Variety Camp Behavior Policy and agree to abide by the guidelines.(Required)

Yes

Variety is committed to making the camp experience the very best for your child and your assistance is key in this commitment.

At the conclusion of camp Variety will distribute a survey seeking feedback on your camper's experience. We will use this information to guide the development of future camps.

In addition to improving the experience for your child, this information is also critical in summarizing outcomes that are accomplished in camp. Grant applications and other funding opportunities that assist in bringing this camp to life often require outcome measurements.

It is therefore a requirement/expectation that each family will complete a camp survey upon receipt of the survey. Failure to complete the survey may impact future camp attendance.

Untitled(Required)

I have read the statement above and will comply with the request.

Register for Summer Adventure Camp 2022

Register Now for Summer Camp 2022

Camper Information

Parent/Guardian Information

Additional Health Information

Preferences

General Information

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

Media Release

Variety Camp Behavior Policy

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