Rainbow Tree - Registration Form
WELCOME TO RAINBOW TREE! We are so excited to see you at camp! If you have not sent payment or completed the payment on the website or made other arrangements with Lisa Haverly for check payment, please do so by going to the following web address:
www.rainbowtreetherapies.com
or you can contact Lisa at
rainbowtreeinfo@gmail.com
. Thank you for completing the registration form.
* Required
Email address
*
Your email
May we contact you via email regarding your child?
*
No I do not give permission for email communication.
Yes I give permission for email communication.
Camper's First Name
*
Your answer
Camper's Last Name
*
Your answer
Child's Date of Birth - NOT REQUIRED FOR PARENT CAMP
*
MM
/
DD
/
YYYY
Age
Your answer
Gender
Male
Female
Clear selection
Register for the following Sessions:
*
Handwriting Enrichment - Summer 2021
ALL GIRLS CAMP - LESS STRESS MORE CONNECTION 13 and UP
ALL GIRLS CAMP - SUMMER ages 10-13
Find Your Rhythm Session 1 . (Morning ages 4-8) -
Find Your Rhythm Summer Afternoon Session (ages 9-13)
All Boys Social Skills Camp - Summer in JuNE
Hike to Health Summer
Other:
Required
Emergency Contact/Liability Docs/Permission Docs
The below information will be utilized in replace of an electronic signature. By clicking the agree boxes, you will be agreeing to the liability information and permission document details. All details of the below can be viewed under the Frequently Asked Question page on the website.
https://www.rainbowtreetherapies.com/pages/liability-documents
First Name of Parent/Caregiver
Your answer
Last Name of Parent/Caregiver
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Contact- Name & Phone Number
Your answer
Name of Emergency Contact (in the event you cannot be reached)
Your answer
Emergency Contact's Phone Number
Your answer
RELEASE OF LIABILITY
*
Please review details of liability by clicking link:
https://www.rainbowtreetherapies.com/pages/liability-documents
I have read the liability information and agree to its contents.
Required
PHOTO RELEASE
*
Please review details of photo release by clicking link:
https://www.rainbowtreetherapies.com/pages/liability-documents
I GIVE consent to take photos.
I do NOT give consent to take photos.
CHALLENGING BEHAVIOR PLAN
Please review details by clicking link:
https://www.rainbowtreetherapies.com/pages/liability-documents
I have read the information on the challenging behavior plan and agree to its contents.
Not Applicable for Parent Camp
Clear selection
CONSENT FOR MEDICAL TREATMENT
*
Please review details of medical treatment form by clicking link:
https://www.rainbowtreetherapies.com/pages/liability-documents
I give CONSENT for life saving medical treatment.
I do NOT give consent for medical treatment. I will describe below my treatment wishes.
If you checked I do NOT give consent to medical treatment, please provided a brief explanation for wishes for medical treatment.
Your answer
COVID MEASURES - By checking each box, you agree to the safety measures.
*
I will not travel by plane the two weeks prior to camp start date.
I will not knowingly send my child to camp with viral symptoms of any kind.
I will not send my child to camp if anyone in my household is sick with any type of viral symptomes.
I understand that my child will be expected to use hand sanitizer upon arrival to camp.
I understand that no staff or other campers will be required to wear masks.
I understand and accept the risk of sending my child to camp.
I assume full responsibility for my child's medical needs and hold harmless Rainbow Tree Therapies, LLC and all of their staff.
Required
COVID-19 INFORMED CONSENT - CLICK HERE TO READ
https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:1a664a19-4f13-4273-94f7-575ccfc9cee5
*
I AGREE TO THE INFORMED CONSENT AND WILL PLAN TO PRINT AND SIGN OR SIGN UPON ARRIVAL (YOU WILL PROVIDE YOUR OWN PEN)
Required
Therapeutic Riding and Animal Assisted Therapy Release
*
Please review details by clicking link:
https://www.rainbowtreetherapies.com/pages/liability-documents
I have read the release of liability and hold harmless document AND agree to its contents.
Not Applicable for Parent Campers
Required
Physical and/or Dietary Restrictions
PLEASE DESCRIBE.
Your answer
Allergies (seasonal, food, bug)
Please describe and treatment protocol.
Your answer
Medications & reason for taking.
Your answer
Has your child ever had a seizure? Have you as a parent camper ever had a seizure?
Yes
No
Clear selection
Areas of special need, challenge or significant medical condition?
Your answer
Does your child have an IEP, receive OT, PT or Speech or have any other specialized support?
IEP
OT
PT
Speech
Counseling
Not Applicable
Other:
Please describe your child's special interests and talents or anything else you would like us to know about your child. Thank you!
Your answer
Comments or Questions?
Your answer
“I understand that Rainbow Tree Therapies, LLC will maintain my privacy to the highest standards. I understand that personal information will not be shared with anyone not affiliated with Rainbow Tree Therapies, LLC. I understand that personal information received through this registration will only be shared with professional staff and volunteer staff at Rainbow Tree to ensure the safety of my child and to ensure my child receives appropriate support needed while at camp."
*
Yes
Do you wish to be added to the mailing list to be updated on future events?
*
***Your email address will not be used for any purpose other than to provide you with information. At any time, you can be removed from the mailing list.
Yes
No
I am already on the mailing list
Required
Do you wish to be added to a carpool document? By saying yes, you would be agreeing to having first name, email address and the town in which you live added to a list. The list would be sent to families who have inquired about carpooling. This does not guarantee a carpool for transportation.
Not an option for 2020
Other:
Clear selection
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