CAMP ENDEAVOR IS BACK JULY 6TH-12TH

Camper Application

Camp Dates: Sunday, July 6th - Saturday, July 12th, 2025

Camper Eligibility Criteria: Deaf or Hard of Hearing children, Siblings of Deaf or Hard of Hearing Children, or Children Of Deaf Adults (CODA); Ages 8 to 16 years old.

Camper Tuition Fee: $250.00 per camper. All Payments must be processed through the Camp Endeavor CAMPER’S CORNER tab.

Applicant Information:

Camper's First Name

Camper's Last Name

Birthday

Month

Day

Year

Gender:

Male

Female

What school do you attend?

What grade will you be completing this school year?

My camper is:

Deaf/Hard of Hearing

CODA (Child Of Deaf Adults)

Hearing sibling of a Deaf/Hard of Hearing camper

Camper's Communication Mode: Sertoma Camp Endeavor operates with ASL as it's main mode of communication. Campers will be encouraged not to speak to promote an immersive ASL experience.

Has your camper ever attended a summer camp before? If so, what camp?

How would you describe your camper's swimming skills?

Beginner (little or no swimming ability, stays in shallow water with life jacket)

Intermediate (Has some swimming ability, stays in life jacket but free swim)

Advanced (Swims well, can swim freely in lake area)

Campers shirt size:

Parent/Guardian Information:

Mother's Name (First Last)

Address:

Phone:

Email:

Father's Name (First Last)

Address:

Phone

Email:

Medical History:

Explain any boxes checked above:

List all medications prescribed by a doctor: (medications brought to camp must be in the original prescription bottle, with correct dosage and directions on the label)

List any activity restrictions prescribed by a doctor:

Does your child need assistance with any of the following?

Toileting

Showering

Eating

Dressing

Does your camper have any fears or phobias we should be aware of?

Does your child have any additional disabilities or special needs? If yes, please describe in detail.

Emergency Contacts:

1st Emergency Contact Name (First Last)

Phone

2nd Emergency Contact Name (First Last)

Phone

3rd Emergency Contact Name (First Last)

Phone

Parental Consent:

My child may participate in any camp-sponsored field trips away from Sertoma Camp Endeavor premises and be transported by vehicles driven by designated licensed staff.

YES

Photographs may be taken of my child during camp activities. The photos may be used for publication or other media use related to the operation or promotion of Sertoma Camp Endeavor’s program.

YES

My child may participate in ALL camp activities. If no, please list activities to be excluded:

YES

Activities not permitted:

Parent/Legal Guardian Signature

Signature field is empty.

Indemnification Agreement:

I agree to indemnify, hold harmless, and defend Sertoma Camp Endeavor and their respective employees, agents, and representatives from and against any all liabilities, claims, or demands which may be asserted against any of them in connection with our applicant’s participation in Sertoma Camp Endeavor. This includes holding Sertoma Camp Endeavor harmless for any injury or illness while on Sertoma Camp Endeavor Property or which may occur to your child while travelling to and from the camp facility.

Parent/Legal Guardian Signature

Signature field is empty.

Code Of Conduct:

I understand that the following are prohibited at Sertoma Camp Endeavor: alcohol, tobacco, or illegal drugs, discriminatory comments, violence, sexual conduct, and inappropriate clothing and jewelry. I understand that the applicant is responsible for his/her conduct at all times and must comply with safety regulations, environmental protections policies, and behavior standards of Sertoma Camp Endeavor. I understand that any violation of the above will be grounds for expulsion with no refund.

In the past, Camp Endeavor has had a serious issue with campers excessively talking, WITHOUT the use of sign language- this ends up having D/HH campers and staff feeling “left out”. To encourage a Deaf-friendly environment, campers who are warned repeatedly will have consequences, including being sent home, if the camper continues to refuse. Although flexibility will be given to those who are still learning and our younger campers, ALL campers will be asked use Sign Language, to the best of their ability, AT ALL TIMES. Staff members will also be held to the same expectations. If you have any questions, please feel free to ask at check-in.

Parent/Legal Guardian Signature

Signature field is empty.

Authorization for Emergency Medical Care:

In the event that the parent/guardian and emergency contacts listed cannot be reached in an emergency, I hereby give permission for the camp medical director to secure and administer necessary treatment, including hospitalization, for my child. I will assume financial responsibility for such arrangements.

Parent/Legal Guardian Signature

Signature field is empty.

Don't forget to download and submit an up to date physical form in the CAMPER'S CORNER. Campers must have an updated physical on file to attend Camp Endeavor.