Variety Camp Registration Long Form

There is a $100 per week refundable deposit (we will hold, but not deposit your check) to attend camp. If your child/teen attends one week, send in one check for $100. If your child/teen attends two weeks, send in two checks for $100. The deposit is refunded if the camper attends their registered sessions, or if the child is unable to attend due to medical or health issues.

If you are new to Variety's Camp, we require a parent/guardian and the camper to meet with Variety's Camp Manager. Once your registration long form is received, the Manager will contact you to schedule a meeting.

Your camper must have an up-to-date physical on file. If you need more information, please contact:

Variety is committed to making the camp experience the very best for your child and your assistance is key in this commitment.

At the conclusion of camp Variety will distribute a survey seeking feedback on your camper's experience. We will use this information to guide the development of future camps.

In addition to improving the experience for your child, this information is also critical in summarizing outcomes that are accomplished in camp. Grant applications and other funding opportunities that assist in bringing this camp to life often require outcome measurements.

It is therefore a requirement/expectation that each family will complete a camp survey upon receipt of the survey. Failure to complete the survey may impact future camp attendance.

* Indicates required field

Camp Dates

Please select camp weeks in order of preference. Campers will only receive two weeks of camp. Adventure Camp is for those 4 to16 years old. Teen Camp is for those 14 - 20 years old.

Camper Information

Your answer will not affect the status of your application, and is not required. Variety uses this information when applying for grants and for reporting purposes.
Each camper will receive one complimentary t-shirt.
Please describe your child's seizures:
Enter details of your child's diagnosis.

Parent/Guardian Information

Additional Health Information

Enter any additional health related information that will assist camp staff in helping your child have a successful camp experience.
Enter any personal care needs details you feel Variety staff should be aware of.
Select all that apply.
Select all that apply.
(i.e., peanuts, bee stings, latex)
(i.e., gluten free diet, low sugar, low carb, etc.)

General Information

Having a behavior plan in no way disqualifies any child from participation in Variety Camp. If your child does have a behavior plan, please fax or mail a copy to Variety. Feel free to provide details or alter procedures for camp setting. Please share this plan with your child’s counselor.

Additional Contact Information

Enter contact information for the individual we should contact in the event of an emergency and we cannot reach you.

Persons Authorized to Pick Up Camper

Enter the name and primary phone number for up to three individuals to whom you give authority to pick up your child from camp.

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT EMERGENCY MEDICAL CARE – PHOTOS

I am the ward or guardian of above camper, (“the child”). I am responsible for the child and have authority to sign this release on behalf of the child. Variety the Children’s Charity of St. Louis (“Variety the Children’s Charity of St. Louis”), is sponsoring 2019 ADVENTURE AND TEEN CAMP, held at various locations.

Either the child by him or herself, I by myself, or the child and I together wish to participate in the event. There is no charge to us for our participation.

The event will include transportation to and from the site by private car and/or other transportation means, entry into the site, and activities at the site.

I acknowledge that participation in the various phases of the free event will involve the risk of injuries and damages including but not limited to injuries or damages resulting from car accidents and/or falls and/or other mishaps. Injuries and/or damages could include death, personal injury, property damages, loss of services and other injuries or damages.

I understand that unless I sign this release, including all its terms, on behalf of the child and me, the Variety the Children’s Charity of St. Louis will not allow the child or me to participate in the event.

In order to participate in the event, on behalf of the child and myself, I therefore release the officers, directors, agents, affiliates, sponsors, volunteers, successors, assigns and employees of both the Variety the Children’s Charity of St. Louis and the site, and I release all drivers and owners of all vehicles involved in the transportation of the participants, (collectively “the released parties”), from all liability for injuries or damages resulting from activities connected with the event, to the extent those injuries or damages are result of negligent acts.

I further agree to hold the released parties harmless and to indemnify them against any claims brought against them by third parties due to my actions and/or the child’s actions.

On behalf of the child and myself, I thus hereby release the released parties from all claims for damages or injuries for negligent acts connected with the event. I exclude from the release grossly negligent acts, intentional acts, and acts done with malfeasance.

I understand this release is quite broad, but I nevertheless accept its terms.


Should the need arise in the course of the event I also hereby give authority to all representatives of the Variety the Children’s Charity of St. Louis and the site to provide reasonable emergency medical care to the child and/or to me. I release all claims for injuries or damages incurred by me or the child in connection with the delivery of such care in good faith. This release is also a condition of participation in the event.


I also hereby authorize the media and/or representatives of the Variety the Children’s Charity of St. Louis to take photographs and/or videos of the child and me, and to publish and/or air those photographs and/or videos for the purposes of publicity and/or other reasonable purposes.

Variety Camp Behavior Policy

The mission of Variety Camp is to provide a supportive environment where children with physical and developmental disabilities can succeed and gain skills, self-esteem, confidence & independence.

Variety wants your camper to have a successful camp experience. We feel that all campers, staff, and volunteers should feel safe and comfortable in our program.

Variety staff will contact you if your child is having a difficult time participating in activities. Specific follow-up plans will be put in place following a parent-staff discussion.

If the camper’s actions continue to be an issue, Variety Camp reserves the right to dismiss your child if he or she exhibits inappropriate behavior or is not having a successful recreational experience. This includes, but is not limited to, participants that exhibit aggressive behaviors, cause harm to either themselves or others, or is unable to be redirected. Dismissal is done at the discretion of the Camp Manager.

If your child has an IEP, 504 Plan, or any other behavior plan in place during the school year which would be beneficial at camp, please feel free to send this in with your application. Please only send portions that you feel would relate to the camp experience.

Variety is committed to making the camp experience the very best for your child and your assistance is key in this commitment.

At the conclusion of camp Variety will distribute a survey seeking feedback on your camper's experience. We will use this information to guide the development of future camps.

In addition to improving the experience for your child, this information is also critical in summarizing outcomes that are accomplished in camp. Grant applications and other funding opportunities that assist in bringing this camp to life often require outcome measurements.

It is therefore a requirement/expectation that each family will complete a camp survey upon receipt of the survey. Failure to complete the survey may impact future camp attendance.