Riley Center Fall Camp Registration Form
Thank you for your interest in Riley Center Recreational Fall Camp - taking place November 24 - November 28th, EXCEPT Thursday November 27!

 9:00am-3:00pm

Please fill out the following registration form by Friday, November 14.

Please email ammendez@mygiantsteps.org with any questions.

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Camper's Name
Camper's Age
List any allergies or dietary restrictions.
List medications.
(Please note only medications that we would need to administer.)
Does your Camper have Asthma?
Clear selection
Does your Camper have Seizures?
Clear selection
What are you Camper's toileting support needs?
Clear selection
Safety concerns (Check all that apply)
What is your Camper's suggested support level? 
(This could change through talks with program staff or through trial.)
Guardian Info 
All correspondence and invoicing will be sent to this person.
Guardian Name
Email Address 
Phone Number
Relationship to camper
Prefered way of contact
Clear selection
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship to Camper
List of people able to pick up Camper
What Fall Camp days will Camper participate in?
Check all that apply.
THANK YOU
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