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Summer Camp Registration and Info Request
Select Session:

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Email Address (Required)
Your Address (Required)
Street Address is Required to send you camp details.
Address 2
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City (Required)
Your City is a Required Field
State (Required)
Last Name (Required)
Sorry, the text in the Last Name field is invalid. Only Letters and Dashes (-) are allowed.
First Name (Required)
Sorry, the text in the First Name field is invalid. Only Letters and Dashes (-) are allowed.
Phone Number (Required)
Please enter your phone number, using only digits or digits and hyphens (-)
Number of Children to Attend?
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Zip Code (Required)
Your Zip Code is a Required Field. Please ensure all 5 digits are included.
   
Camper 1 (Required)
i.e. John Doe

Camper 1 Name has an error. It can only contact letters and hyphens (-)
Disability? (Required)

For camp planning purposes, we need to know if this camper has a documented disability or not.
DOB
mm/dd/yyyy

Camper 2 Date of Birth is incorrect. Please Enter the Date as (MMDDYYYY or MM/DD/YYYY or MM-DD-YYYY)
Camper 3
Camper 3 Name has an error. It can only contact letters and hyphens (-)
i.e. John Doe
Disability?

For camp planning purposes, we need to know if camper 3 has a documented disability or not.
DOB
Camper 4 Date of Birth is incorrect. Please Enter the Date as (MMDDYYYY or MM/DD/YYYY or MM-DD-YYYY)
mm/dd/yyyy
Please outline any special needs, the campers you listed may have, including special supports, allergies etc...
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Can they Transfer out of their wheelchair?
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DOB (Required)
mm/dd/yyyy

Camper 1 Date of Birth is incorrect. Please Enter the Date as (MMDDYYYY or MM/DD/YYYY or MM-DD-YYYY)
Camper 2
Camper 2 Name has an error. It can only contact letters and hyphens (-)
i.e. John Doe
Disability?

For camp planning purposes, we need to know if camper 2 has a documented disability or not.
DOB
Camper 3 Date of Birth is incorrect. Please Enter the Date as (MMDDYYYY or MM/DD/YYYY or MM-DD-YYYY)
mm/dd/yyyy
Camper 4
Camper 4 Name has an error. It can only contact letters and hyphens (-)
i.e. John Doe
Disability?

For camp planning purposes, we need to know if camper 2 has a documented disability or not.
Do any of these children use a wheelchair?
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How did you hear about V-LINC? (Required)
Letting us know how you heard about us is helpful, enter Other if preferred.
(Agency, Ad, Magazine, Web Search etc...)
Camp ends at 3pm, all campers need to be picked up promptly at 3pm. (Required)

Captcha Captcha
  Refresh
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Pictures and Video are frequently taken during camp, a camp video is created by the campers, and pictures and the camper made video is posted on our Website, E-News, Facebook Page and/or YouTube Channel. Do you have any objections to your child(ren)'s appearance in these mediums? (Required)
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