Summer Camp Form – Spectrios

Summer Day Camp

Complete this form to begin the registration for Spectrios "Grandma Martyl" Summer Day Camp.

Camper Name

First

Last

Guardian Name

First

Last

Relationship to Camper

Guardian Phone

Guardian Email *

Emergency Contact Name

First

Last

Relationship to Camper

Emergency Contact Phone

PICK UP PERMISSIONS: Only the person(s) listed below will be allowed to pick up my camper from Spectrios. A valid driver's license may be asked for identification.

How did you hear about Grandma Martyl Summer Day Camp? *

This camp is for rising 6th to 12th grade students with low vision. What grade will your camper be entering in the fall?

What, if any, special assistance will the camper need during the camp? If none, please indicate that.

Lunch and snacks will be provided every day. Does your camper have any dietary restrictions including food allergies or sensitivities?

What is your camper's t-shirt size? Please indicate Youth or Adult S/M/L/XL

I give permission for my camper to be photographed by Spectrios Institute for Low Vision. I also grant the right to use photographs for advertising or marketing efforts associated with the Grandma Martyl Low Vision Summer Day Camp.

Yes

The registration fee for the camp is $50 which includes lunch, snacks and costs associated with ticketed activities. Payment can be made via check or cash and brought to Spectrios on the first day of camp. Scholarships are available.

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