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2022 Online Camper Registration Form

Camp Sparkle Online will take place Mon. July 18 - Fri. July 22 from 10am-1pm PST (1pm-4pm EST) via Zoom. Online camp is open to any child living in the U.S. and is perfect for kids in treatment or those unable to attend an in-person offering.

If you are attending an in-person camp, we still invite you to attend online camp too! Please still fill out this separate registration form. 

General Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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First Name
Last Name
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They will receive this letter prior to the week of camp.
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Cancer Information
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CONSENT AGREEMENT, AUTHORIZATION, AND RELEASE

This consent agreement, authorization, and release must be read and signed for the participant to be eligible to attend Camp Sparkle and other Cancer Pathways programs.  For participants under age 18, this form must be completed and signed by parent/guardian.

Participation Consent
I give permission for my child to participate in any and all activities of Camp Sparkle, including programs that are offered using technology-assisted media such as video conferencing, social media platforms, and email. Virtual Camp Sparkle programs will primarily be offered using the Cancer Pathways Zoom Business platform. It is your responsibility to communicate only through devices that you know are secure and to be aware that family, friends, employers, co-workers, strangers, and hackers could either overhear your communications or have access to the technology that you are interacting with. Additionally, you agree not to record any camp sessions. If you identify a need for clinical mental health treatment and/or in-person services, it is your responsibility to contact practitioners or contact your primary care physician. You are welcome to contact social worker, Michelle Massey, MSW, LICSW, OSW-C to discuss referrals. By signing this you understand that it is your responsibility to identify your need for mental health treatment and you are responsible for obtaining a mental health provider of your choice.
Release of Liability
Recognizing that Cancer Pathways will do its best to ensure a safe experience, I understand that participation in Camp Sparkle virtual programs carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid damage or injury. By signing below, I release Cancer Pathways, its employees, volunteers, independent contractors, directors and agents from all liability based on any emotional damage or loss whether it is the result of ordinary negligence or otherwise, caused to my child or to me from participation in the Virtual Camp Sparkle program.
Photo and Information Release
I hereby give Cancer Pathways and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child during Virtual Camp Sparkle for use in audio, video, film, or any other electronic, digital and printed media in order to promote or market Camp Sparkle. This is with the understanding that neither Cancer Pathways nor its representatives will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for my child’s participation. I further release and relieve Cancer Pathways, its Board of Trustees, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. The camp respects the privacy of its participants and does not allow unauthorized visitors to photograph the camp or camper.
Privacy Policy
Cancer Pathways collects the above personal information for the purpose of Camp Sparkle registration, camper safety and other camp planning purposes. This information will be kept confidential and will never be shared or sold to outside organizations, groups or individuals. Parent's have the right to review their child's Camp Sparkle information or ask for the information to be deleted at any time.
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