Indianapolis, IN Area Camp
August 16-18, 2024
Waycross Camp | Morgantown, IN
Secure Online Event Registration
We're glad you're interested in Stroke Camp! Please fill out this registration form in its entirety and submit ASAP! Camp fills up fast and rooms are assigned on a first come, first served basis.
*Shirt sizes are not guaranteed for registrations received less than three weeks prior to camp!
IMPORTANT
PLEASE READ:
Registration will be done individually, one person at a time. Once the first person has registered, you will have an opportunity to add a second person by entering their information and so forth. Registrants will be added by pressing the green "Add Registrant" button located right before the BILLING INFORMATION. (If there is a waitlist, that option will not be available and registrants will need to register separately.)
In celebrating 20 years of Stroke Camp, we are bringing back some of the best and brightest moments experienced over the past 20 years. Some Jeopardy, a talent show, classic skits, and more await...
Minimum $50 (NONREFUNDABLE) per person deposit is requested with this registration. Remaining balance paid by credit card is automatically deducted on March 8th. Final cash or check payments are accepted during registration at camp -refunds are made ONLY in the case of a MEDICAL emergency
**Because of limited spots available, please keep additional attendees (anyone in addition to a survivor and caregiver) to a minimum.
age 16+
age 5-15
age 4-under
Our best efforts will be made to accommodate your request , however if you are concerned about having food available that you can eat, we suggest bringing snacks and/or food to supplement your diet.
(**Your name, address, phone number, email address, and stroke date will be distributed to all in attendance at camp. All other information obtained for Stroke Camp is solely used in the event of a medical emergency and will be kept secured and confidential.)
For your convenience, we have included the health history form into this registration. You may fill it out now to save time later, print the PDF and fill it out and send it in to us (it will be included in the confirmation email), or fill it out at camp.If you are filling it out now, please complete ALL requested information. EACH CAMP PARTICIPANT is asked to complete a health history form. This does NOT need to be completed by a doctor!
The Health History Form is required for EACH camp participant (stroke survivors, caregivers, family members, and friends). All information being collected for the Stroke Retreat is solely to be used in the event of a medical emergency.
United Stroke Alliance®, a tax-exempt organization, also known as Retreat & Refresh Stroke Camp®, hosts camps for caretakers and survivors of stroke (the “Camp” or “Camps”).
I hereby Authorize United Stroke Alliance (“USA”) to use, publish, and/or otherwise disclose my Individual Identifiable Information, which includes but is not limited to: my name, image and likeness, voice and/or picture (my “Information") as described below. This authorization is voluntary, and no individual has coerced or forced me into agreeing to this authorization.
I understand that USA may benefit, monetarily, non-monetarily, or otherwise, from the use of my Information. I understand that I will not be entitled to any compensation for use of my Information, and I specifically release all claims against USA for the same. I understand that once my Information is received by USA, that it may be subject to use, publication or disclosure. I waive any claims of violations of federal, state, or local laws which are the result of said use, publication or disclosure.
A. Individual Identifiable Information includes, but is not limited to:
B. Use and Media, my Information may be used
C. Right to Revoke
I acknowledge that I have the right to revoke this authorization in writing by contacting United Stroke Alliance. Any revocation will be prospective and not retrospective meaning USA will have no obligation to remove or edit out my Information from previously published media.
BE SURE TO KEEP CHECKING YOUR EMAIL
You will know that you are registered if you get a confirmation email.
You will receive information through email about camp APPROXIMATELY a week or two before camp.
Always make sure you check your SPAM or JUNK folders
NEED TO REGISTER ANOTHER PERSON??
PLEASE READ CAREFULLY:
Simply click the GREEN button that says "ADD ANOTHER REGISTRANT" just below this paragraph.
You will then be taken to the top to fill out whole new form for the other registrant. This will happen for every registrant that you decide to add.
You will see, "Registrant #2" with an arrow pointing down. You can display or hide any registrant's form by pressing those arrows.
WHEN FINISHED with ALL the forms and the Billing Information, scroll down to the GREEN button that says "SUBMIT" to submit your form.
IF YOU ARE HAVING A HARD TIME SUMBMITTING...make sure you've filled EVERYTHING out properly and that required fields are filled out. The system will alert you if you don't and will indicate that it's not filled out or not filled out properly by either highlighting it in RED or outlining it in RED with a triangle with an exclamation point by it.
