Fall Farm Adventure Event

Fall Farm Adventure Preregistration is OPEN

Contact ekaamp@chasing7dreams.org for more info

Fall Farm Adventure Event 2026 Preregistration

 

To be added to the waitlist, please fill out the form below:

PARTICIPANT'S NAME *

PARTICIPANT'S NAME

First

First

Last

Last

PARTICIPANT'S DOB *

Participant's Age *

ADDRESS (STREET NUMBER) *

ADDRESS (CITY, STATE, ZIP) *

COUNTY *

Is the participant an Inland Regional Center client? * YesNo

Are your services through Inland Regional Center or Self-Determination? * IRCSelf-determinationNeither

FMS Provider *

FMS Point of Contact Name *

FMS Point of Contact Name

First Name

First Name

Last Name

Last Name

FMS Point of Contact Phone *

FMP Point of Contact Email *

Would you like to receive more information about potential scholarships? * YesNo

UCI# *

CSC Worker's Name

CSC Worker's Name

First Name

First Name

Last Name

Last Name

CSC Worker's Phone #

CSC Worker's Email

Parent/Guardian's Name *

Parent/Guardian's Name

First

First

Last

Last

Parent/Guardian's Phone Number *

Parent/Guardian's Email *

Each registered participant must be accompanied by a guardian 18 years or older. Will the listed primary guardian be attending with the participant to this event? YesNo

Name of guardian attending with participant *

Name of guardian attending with participant

First Name

First Name

Last Name

Last Name

Phone number of guardian attending *

Email address of guardian attending with participant

How many people will be in your party (including the participant)? *Keep in mind, this event is limited to one parent/guardian per party *

Has your child ever attended a Chasing 7 Dreams event before? YesNo

How did you hear about us?

Please list one of your child's IPP goals *

*

Upon submitting your registration, please contact your CSC immediately to inform them that your child plans to participate in this program. This will initiate the required authorization and approval process.Please note that authorization must be received at least fourteen (14) days prior to the first day of camp. If authorization is not received by this deadline, the participant will be withdrawn from the camp. If you are unable to reach your CSC, please press “0” to speak with a duty officer. You may also contact us directly, and we will provide additional information to help connect you with your CSC or PM, including email addresses and phone numbers. After completing your registration, you will receive a confirmation email from the respective program coordinator acknowledging that your registration has been received. We will copy (CC) your IRC caseworker on this email with instructions to help initiate services and ensure that authorization can be processed promptly.If CSC information is not included on the registration form, we will contact you immediately by email, as this information is required to obtain approval. To agree, please initial.

Initials *

*

By initialing on this line, I as a participant involved in Chasing 7 Dreams programs accept that I may be photographed or videotaped. I also accept that these images may be used for educational, promotional marketing, training, or research purposes by staff members of Chasing 7 Dreams. I understand, participate, and agree that I and my child (if applicable) whom is under the age of 18 years old to be photographed or videotaped and is given the right to have access to photos or videos if desired.

Initials *

Submit

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