Youth Outdoor Equity 2026 Summer Program with Connections for Independent Living

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Thank you for your interest in our Youth Outdoor Summer Camp. This camp is specifically designed for youth ages 14–17 who identify as having a disability. Completion of this form confirms eligibility and helps us provide appropriate supports.

All information will be kept confidential and used only to support your youth’s safety, accessibility, and participation.

Youth's Full Name *

Youth's Date of Birth *

Pronouns (optional)

Youth's phone number (if applicable) *

Youth's email (if applicable) *

Parent/Guardian Full Name(s) *

Relationship to Youth *

Phone Number(s) *

Email address *

This camp is intended for youth with disabilities. Please list primary disability/disabilities: *

Which city/town does the youth live? *

What accommodations, supports, or modifications will help your youth fully participate? *

Would you like us to provide transportation to & from? Please provide details if needing transportation for all or specific dates. *

Please list any allergies and describe severity of reaction (food, medication, environmental, insect, etc): *

Lunch and snacks will be provided. Please list dietary restrictions or preferences: *

Has your youth attended this program before? What is your youth most excited about for the Youth Equity Summer Program for 2026? *

Thank you for completing this form. We will be in touch soon for next steps! Any other information or questions please include here:

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