Camper First Name / Last Name
*
First Name
Last Name
Camper Email
Camper Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Camper Date of Birth
*
MM
DD
YYYY
Gender
*
Camper Status
*
If you selected "First Time Camper" please select the amount of weeks attending from the drop down menu.
1st Week
1st Week - 4th Week (Entire session)
Full Name (Parent of Guardian)
*
First Name
Last Name
Relationship (Parent or Guardian)
*
Phone (Parent or Guardian)
*
(###)
###
####
Email (Parent or Guardian)
*
Full Name (Emergency Contact)
*
First Name
Last Name
Relationship
*
Phone
(###)
###
####
Email
*
Address 1
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Address 2
Please list a second emergency contact
First Name
Last Name
Phone number for second emergency contact
(###)
###
####
Certification - If your camper has any of the below certifications, check the corresponding box. Proof of certification will be required.
Camper Swimming Proficiency
*
Non-swimmer (does not know how to swim)
Basic swimmer (has fundamental swimming ability)
Average swimmer (has a good understanding of swimming & swims often)
Good swimmer (is comfortable in almost any depth of water)
Camper T-Shirt Size
*
Youth Small (8 - 10)
Youth Medium (12-14)
Youth Large (16 - 20)
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
English Language Proficiency
*
None
Basic
Intermediate
Fluent
Native
Russian Language Proficiency
*
None
Basic
Intermediate
Fluent
Native
My camper will need to use the ORPR Transportation Assistance Program from/to Chicago's O'Hare airport (ORD)
*
Please attempt to make reservations for your camper(s) to arrive at O'Hare on Saturday July 6th between 8 a.m. and 2 p.m. with the return flight departing no earlier that 4 p.m. on Saturday August 3rd.
Please email apps@orprcamp.org with the proposed itinerary and wait to receive a reply before making final reservations.
Would you (parent or a grandparent) like to volunteer during the camp session?
*
Code of Conduct Cont.
*
As a camper at ORPR Camp, I promise to abide by this Code of Conduct.
*
DISCLAIMER: By typing your name below, you have read and understood the Code of Conduct and that you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
*
Signature of Camper
*
Date
*
MM
DD
YYYY
DISCLAIMER: By typing your name below, you have read and understood the Code of Conduct and that you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
*
Signature of Parent
*
Date
*
MM
DD
YYYY
Attendance Agreement
*
Permission and Waiver of Liability - I give permission for my child to attend O.R.P.R. Camp, Inc. (hereinafter “Camp”) and participate in all phases of the Camp program and activities. I understand that (check next to each paragraph):
*
Permission and Waiver of Liability
*
Agreement to Arbitrate
*
Code of Conduct
*
Code of Conduct Continued*
*
Signature of Parent of Legal Guardian
*
First Name
Last Name
Date
*
MM
DD
YYYY
Media Consent Form 2024
*
Signature of Parent/Guardian:
*
First Name
Last Name
Date
*
MM
DD
YYYY
CAMPER MEDICAL INFORMATION - All Campers must have medical coverage by their family medical insurance policy (include a copy of the front and back of the insurance cards). ORPR Camp provides no medical insurance. Any medical costs incurred by the camp in providing required treatment to your Camper will be billed to the parents.
*
Medical Insurance Co. Name:
*
Medical Policy Number and contact phone number:
*
Does your child have any known allergies, including environmental, bee stings, etc.?
*
Does your child have allergies to any medications?
*
Medications he/she is allergic to include:
Does your camper have any allergies to food?
*
Foods he/she is allergic to include:
Does your child have any dietary concerns?
*
Dietary concerns/restrictions include:
Does your child take any prescription medication?
*
Prescription medications he/she takes (list condition requiring medication & medication instructions):
For the safety of everyone, your child is not allowed to have his/her medication on him/her at any time without prior consent from the Camp. Our ORPR Staff will dispense the medication to the best of our ability, per doctor's instructions. Special accommodations can be made for certain medications taken on an as-needed basis, such as asthma inhalers.
*
Does your child have any medical problems? If so, please explain:
*
Please indicate if your child is affected by or has issues with any of the following:
Does your child have any behavioral or social considerations of which their ORPR camp counselor should be aware (Autism spectrum disorder, developmental delay, ADHD, ADD, etc…)?
*
Has your child ever had any disciplinary action taken against him/her at school (served detention, been suspended or expelled)? If you answer yes, please describe circumstances (include dates).
*
COVID-19 STATEMENT: We are closely monitoring the Covid 19 situation and will follow all guidelines set in place by the IL Department of Public Health.
AUTHORIZATION OF MEDICAL TREATMENT: In case of illness or accident, I hereby give permission to ORPR Camp to secure medical treatment for my child at the nearest medical facility. I assume full financial responsibility for all medical costs incurred for such treatment. My medical insurance will be the camper’s coverage.
*
DISCLAIMER: By typing your name below, you have read and understood the Camper Medical Information Form and that you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
*
Signature of Parent or Legal Guardian:
*
First Name
Last Name
Date
*
MM
DD
YYYY
