Visually Impaired Preschool Services (VIPS)     O&M Adventure Summer Camp Registration Form
Thank you to American Printing House for the Blind-Family Connect (APH) for sponsoring this event!  The O&M Adventure Camp is free to all families!  Those families living further than 25 miles from the VIPS Indiana Family Resource Center will be given a travel stipend.  The VIPS Indiana Family Resource Center is located at 1212 Southeastern Ave, Indianapolis, IN 46202.

Please complete this form by May 16, 2022.

You can register your child to attend the camp on the  Monday dates or the Saturday dates.  You must choose one day of the week or the other; days cannot be mismatched.  You may choose to register your child for one, two, or three days of VIPS O&M Summer camp.

The dates for the camp are listed below.

Time slots are divided by the children's ages.  Please choose the time that matches your child's age.

Parents are required to stay at the Family Resource Center for the duration of the camp if their child is three-years-old or younger.  For ages four- to 13+-years, parents are not required to stay at the Center, but they must arrive and enter the VIPS Family Resource Center ten minutes prior to the end of the camp session.

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Email *
Child's Name *
Child's Date of Birth
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Parent(s)' name(s) *
Are you a current VIPS Family *
Phone *
Email Address *
Emergency contact (This should be someone other than the child's parent(s).  Please include the emergency contact's name, phone number, and relationship to the camper.) *
Your child will attend *
Check which days your child will attend.  (A maximum of three checks are accepted.  You may choose either Mondays or Saturdays; no mismatching.) *
Required
What group and time slot will your child attend? *
Medical Information
VIPS needs the following information to ensure your child safety while in our care.
Vision Diagnosis *
Allergies *
Medications *
Does your child have seizures? If yes, please state date of last seizure. *
Does your child currently receive O&M services? If yes, who is your child's O&M specialist?
Does your child have a white cane? *
Almost done!
Once you finish completing this form, you will receive an email that will confirm your registration. There will also be more forms and signatures required in order for your child to attend (additional medical forms, releases, etc.)
T-shirt sizes:  We will only have child and adult sizes available. If these will not fit your child, feel free to select a size for yourself instead!
"I give my son/daughter permission to attend O&M Adventure Summer Camp. I, as a parent, along with my son/daughter are committed to complying with Cane Adventure Camp policies. I acknowledge that more information and releases will be required for my son/daughter to participate in the O&M Adventure Camp. If medical information indicated above additional documentation will be sent to you to complete and return on first day of camp. " Please type your name below if you agree to the above statement. By typing your name, you are providing a digital signature.
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