2023 Camper Registration Part II "*" indicates required fields NEW CAMPER REGISTRATION PROCESS. READ ENTIRELY BEFORE STARTING THE APPLICATION! 1. Registration must be completed by a Parent or Legal Guardian of the camper. 2. Entire Registration is online and in two parts. Part I is for camper information, to submit camper birth certificate and for camp selection. After Part I is processed and payment is made, Part II is to submit a copy of health insurance ID, medical clearance form and provide camper health information. 3. All entries will be processed in order of submission of the application and accuracy/validity of submitted documentation. 4. Camper application will be processed after Part I but a Camper is not enrolled until completion and acceptance of Part II of the application. 5. If any of the submitted information or documentation is inaccurate or cannot be validated, the application will be moved to the end of the waitlist. To avoid getting waitlisted, please take the time to submit accurate & valid information! 6. Space is limited so the best chance for enrollment is to provide complete, accurate, and valid information in a timely manner. No applications or documents will be accepted after the due date. 7. All correspondence will be via parent's email address on this registration form. Please make sure to check your spam folder if you do not see a confirmation email in your inbox after this submission. 8. Multiple registrations for same camper name and birthdate combination are not allowed. 9. All Registrations will be voided if dispute is filed with Stripe, credit card company or bank. 10. All submitted information is stored on a secure website. For more information, please contact onlinereg@vrajyouth.net or visit our website at www.vrajyouth.net. HiddenEntry ID from Part IThis field is not editable and carried over from Part I of the application. Camp applied for:*This field is not editable. HiddenApplication Status from Part IThis field is not editable Parent Email Address*This field is not editable. The application will show the email address from Part I of the application. Parent/Guardian Name*This field is not editable. The application will show the name from Part I of the application. First Last Parent/Guardian Contact Phone*This field is not editable. The application will show the contact number from Part I of the application.HiddenHome Address*This field is not editable and carried over from Part I of the application form. Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Camper Name*This field is not editable. The application will show the name from Part I of the application. First Middle Last Camper Birth Date*This field is not editable. The application will show the birthdate from Part I of the application. MM slash DD slash YYYY Camper Gender*This field is not editable. The application will show the birthdate from Part I of the application. Male Female HiddenSibling in camp?*This field is not editable. It is passed from Part I form. HiddenCamper Email Address*This field is not editable and carried over from Part I of the application. HiddenT-Shirt Size*This field is not editable and carried over from Part I of the application. HiddenNumber of years in camp*This field is not editable and carried over from Part I of the application. HiddenToken Eligibility.This field is not editable and carried over from Part I of the application. Upload Medical Clearance Certificate*Only 1 file upto 2MB in size is allowed. A free mobile app such as DocScan by IFUNPLAY can be used to scan your document as pdf to meet 2MB size requirement.Max. file size: 128 MB.Upload Proof of COVID Vaccination*Only 1 file upto 2MB in size is allowed. A free mobile app such as DocScan by IFUNPLAY can be used to scan your document as pdf to meet 2MB size requirement.Max. file size: 128 MB.Does the camper have moderate to severe asthma or allergies?* Yes No Upload Asthma / Allergy Action Plan*Only 1 file upto 2MB in size is allowed. A free mobile app such as DocScan by IFUNPLAY can be used to scan your document as pdf to meet 2MB size requirement.Max. file size: 128 MB.Health Insurance Carrier* Subscriber ID* Subscriber Name* Group Number* Upload Copy of Front of Health Insurance ID*1 file upto 2MB in size is allowed. Make sure that the information on Health Insurance ID matches the health insurance related fields above. A free mobile app such as DocScan by IFUNPLAY can be used to scan your document as pdf to meet 2MB size requirement.Max. file size: 2 MB.Upload Copy of Back of Health Insurance ID*1 file upto 2MB in size is allowed. A free mobile app such as DocScan by IFUNPLAY can be used to scan your document as pdf to meet 2MB size requirement.Max. file size: 2 MB. Camper Health InformationCheck all of the following allergy or medical conditions that apply:*Note that any allergies or medical conditions noted here must match what's on the Medical Clearance Form provided by a Physician. None Certain Foods Certain Medicines Bee Stings/Insects Seasonal Changes Other Provide specific information. e.g. Allergic to peanuts.* What are the symptoms your child exhibits when having an allergic reaction/medical condition?* Does your child take any medication for allergies, medical condition, or otherwise?*Note that any prescription medicine noted here must match what's on the Medical Clearance Form provided by a Physician. Daily As needed None Please list medication(s), dosage and frequency, including emergency medicine your child carries.* Is there a need to bring this medication at camp?*If yes, parent to provide all prescription medicine. Yes No Are there any limitations/ restrictions of physical activities at camp due to allergies/medical condition?* Yes No If answered yes to any limitation/restriction, please specify.* Has your child been hospitalized, taken to the emergency room, or visited a doctor due to an allergic reaction or for any medical condition in last three years?* Yes No If answered yes, please explain.* Does the child have ADHD or other related disorder that camp counselors and adult volunteers need to be aware of for the safety of the child and others.*If yes, we will contact you for additional information. Yes No Consent*- I give permission for my child to receive the above medication as directed. - I understand that food may be cross-contaminated. Vraj camp has no physician and is located in rural Pennsylvania with Emergency facility approximately 45 minutes away. My child is trained (if he/she is prescribed) to administer all regular and emergency medications, including Epipen, without any adult supervision. - I will send all his/her regular and emergency medication with him/her to Vraj Camp. - I assume complete financial and other responsibility for all and every health and accident related expense for my child while he/she is at Vraj premises or on any excursions that he/she may take part in while attending Vraj Camp. - I undertake to hold the Vraj temple organization, all its employees, volunteers, counselors and campers harmless against any action that may arise out of any occurrence involving during Vraj camp. Emergency Contact Name - 1*Must be different than parent information provided in Part I of the application. Both emergency contacts and numbers MUST be different. First Last Relationship to Camper - 1* Emergency Contact Number - 1*Emergency Contact Name - 2*Must be different than parent information provided in Part I of the application. Both emergency contacts and numbers MUST be different. First Last Relationship to Camper - 2* Emergency Contact Number - 2*Cell Phone Policy*Campers are NOT permitted to possess a cell phone for any reason at camp. In case your child is found carrying a cell phone, please understand that the phone will be confiscated and $500 will be charged to receive the phone back. Please review the detailed cell phone policy at Camper Registration. I will pay $500 fine I am interested in volunteering at and/or attending:*Vraj Youth Outreach events benefit our Vraj community. Volunteering at Vraj Temple events can qualify you to request an early camper registration token for 2020 camps. Select all events that you can volunteer at. Please visit vrajyouth.net for detailed information. Vraj Youth Outreach Events - TBD Vraj Youth Networking Events - TBD Vraj Temple Rangotsav on March 5, 2023 Vraj Temple Mahaprabhuji Utsav on April 16, 2023 Vraj Temple Patotsav on May 28, 2023 Vraj Temple Amrakunj/Fireworks on July 1. 2023 Vraj Temple Nand Mahotsav on September 10, 2023 Vraj Temple Rasotsav on October 28, 2023 Vraj Temple Annakut on November 19, 2023 None of the above Parent Signature*This field is not editable. First Last CommentsThis field is for validation purposes and should be left unchanged. Δ