Camp Frog Registration

Camp selection (Pick only the dates that you are able to attend if you are chosen)

Personal Information

Camper's Name
Date of Birth
Will the camper be attending with a parent/guardian?
* Adults and self-guardians will be provided a Buddy/Caregiver form upon acceptance, to be completed prior to camp.

Additional T-shirts for Purchase

Media Release

“I grant permission for those in attendance to be photographed and/or videotaped, with such pictures, video recordings and names to be used in public relations and fund-raising efforts (including websites and social media) to promote programs of Autism Support of Alabama.”

Insurance Information

Agreement and Signature

“I recognize and understand the are inherent dangers and risks associated with the natural environment and through participating in ASA’s Camp Frog’s recreational activities. Accordingly and in consideration of ASA enrolling the above listed in Camp Frog, I, hereby release and hold harmless Autism Support of Alabama and its agents and employees of and from any and all claims, actions, causes of actions, and demands for all injuries, damages, and losses incurred or which may occur to the above attending as a result of, or arising out of, activities during camp.”
Clear Signature
Date / Time