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Camp Bloomfield
Child Development Services (formerly Blind Babies Foundation program)
Child Development Services (formerly Early Intervention or Blind Babies Foundation)
Children and Family Services (formerly Lilliput Families)
Family Resource (NICU) Navigator
Foster Family Services
Kinship Support Services Program
Mental Health Services
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Fact Sheet and Additional Information
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Q&A with our President and CEO
Our Leadership
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Awards and Accreditations
Program Flyers
Ways to Help
Donate Now
Donor Advised Fund
Holiday Toy Drive and Wish List
Planned Giving
Major Gifts
Impact Council
Community Council
Corporate Sponsorships and Volunteer Opportunities
Workplace Giving
Giving Stock or Bonds
In-Kind Gifts
Volunteer Opportunities
Matching Gifts
Small Actions that Make Big Changes
Tribute Gifts
Monthly Giving
News and Events
Join The Conversation
Join us on Derby Day
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Career Opportunities
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Program Areas
Children & Youth Services
Adult Services
Family Services
Find a Program
Adoption Services
Post Adoption Services
Camp Bloomfield
Child Development Services (formerly Early Intervention or Blind Babies Foundation)
Children and Family Services (formerly Lilliput Families)
The Cottage (TSC)
Family Resource (NICU) Navigator
Foster Family Services
Group Homes for Children
Kinship Support Services Program
Mental Health Services
Recreation for the Blind or Visually Impaired
Family Trainings & Workshops
Special Education School
Transition Services
Assistive Technology Training
Camp Bloomfield
Children and Family Services (formerly Lilliput Families)
Davidson Program for Independence (Residential for Visually Impaired)
Employment Services
Group Homes for Adults
The Hatlen Center (Residential for Visually Impaired)
Older Individuals Who Are Blind (OIB)
Orientation and Mobility Training
Recreation for the Blind or Visually Impaired
Transition Services
Adoption Services
Post Adoption Services
Camp Bloomfield
Child Development Services (formerly Blind Babies Foundation program)
Child Development Services (formerly Early Intervention or Blind Babies Foundation)
Children and Family Services (formerly Lilliput Families)
Family Resource (NICU) Navigator
Foster Family Services
Kinship Support Services Program
Mental Health Services
Recreation for the Blind or Visually Impaired
Test Holiday Form
Holiday Party 2023 RSVP
Participant or Volunteer?
Participant
Volunteer
Is the Volunteer a minor?
(Required)
Yes
No
Volunteers under 18 years old are required to have a parent/guardian present during the duration of the event.
Chaperone Consent
(Required)
I understand that I am required to accompany the above minor for the duration of the event.
Chaperone Name
(Required)
First
Last
Relationship To Volunteer
(Required)
Chaperone Email
(Required)
Chaperone Phone
(Required)
Name of Volunteer
(Required)
First
Last
Volunteer Phone
(Required)
Volunteer Email
(Required)
Name of Participant Receiving Wayfinder Services
(Required)
First
Last
Participant Email
(Required)
Home Phone
(Required)
Cell Phone
(Required)
Participant's Vision
(Required)
Totally Blind
Light Perception
Legally Blind (20/200)
Low Vision (20/70)
Sighted (no visual impairment)
Name of Students Teacher for Visual Impairment
Email of Students Teacher for Visual Impairment
NAMES and AGES of all attending
Please list all those who plan to be in attendance
Total Number Attending
1
2
3
4
5
6
more than 6
How many attending
Names and Ages
(Required)
Name
Age
Add
Remove
Click + symbol on the right to add more names
Additional Information
Does the Participant have any medical restrictions?
(Required)
No
Yes
Please describe the medical restriction.
(Required)
Does the Volunteer have any medical restrictions?
(Required)
No
Yes
Please describe the medical restriction.
(Required)
Does the Participant have any serious allergies?
(Required)
No
Yes
Please list the Allergies
(Required)
Does the Volunteer have any serious allergies?
(Required)
No
Yes
Please list the Allergies
(Required)
How did they find out about this event?
Currently enrolled in a Wayfinder Program
Wayfinder Alumni
Other
Please Describe
Reporting Information
Our programs remain free of charge thanks to private funding sources. Some funders ask for the following demographic information. This information will remain anonymous and used for reporting purposes only. Thank you for helping us report accurate information to our funders!
Ethnicity
Caucasian
Hispanic
African-American
Asian
Native American
Other
Total number of adults residing in your home?
Total number of children residing in your home?
What is your household's combined gross annual income from all sources?
Releases and Disclosures
Activity Permission/Opt-Out
(Required)
I have read and agree to the ACTIVITY PERMISSION/OPT-OUT:
I hereby grant participant named above permission to participate in all activities offered by or through Wayfinder Family Services, with the exception of those activities indicated above. The undersigned parent, guardian, or custodian of the above named participant hereby joins in the foregoing Activity Opt-Out Form and hereby stipulates and agrees to save and hold harmless, indemnify, and forever defend Wayfinder Family Services, their directors, officers, agents, employees, and volunteers from and against any claims, actions, demands, expenses, liabilities (including reasonable attorney fees) for negligence as a result of said participant’s participation in the activities of Wayfinder Family Services and his or her use of the property, animals, and facilities. I, on behalf of said participant, further agree not to sue Wayfinder Family Services, its directors, officers, agents, employees, and volunteers as a result of any injury that said minor suffers from negligence in connection with his/her participation in the activities of Wayfinder Family Services.
Consent
(Required)
I have read and agree to the AUTHORIZATION FOR TREATMENT OF ADULT CONSENT, RELEASE, AND COVENANT:
The undersigned parent/guardian represents to Wayfinder Family Services that the minor named in this application is in his and/or her legal custody and control; and that the undersigned desires said minor to participate in the programs of Wayfinder Family Services, and that for purposes of said participation the undersigned agrees, authorizes and states as follows:
In case of medical or dental need or emergency, I (we) understand every effort will be made to contact parents/guardians of children. In the event I (we) cannot be reached, I (we) undersigned, parents/guardians of camper, do hereby authorize Wayfinder Family Services and its officers or staff employees as agent(s) for the undersigned to obtain and consent to any x-ray examination, anesthetic, medical, dental, surgical diagnosis, treatment and hospital care which is deemed advisable by, and is to be rendered to said minor under the general or special supervision of any surgeon licensed under the provisions of the Medical Practice Act or the medical staff of a licensed hospital or by a dentist licensed under the provisions of the Dental Practice Act, whether such diagnosis of treatment is rendered at the office of said physician or dentist or at the said hospital.
I (we) also understand and agree that any and all such medical, dental, hospital or similar expenses incurred in the treatment of my (our) child will be borne by myself (ourselves). We understand that no representation of such coverage exists or is intended by this form.
It is understood that this authorization is given in advance of any specific medical or dental diagnosis, treatment or care being required but is given to provide authority and power on the part of Wayfinder Family Services (as aforesaid) as my (our) agent(s), to give specific consent to any and all such diagnosis, treatment or care which a licensed physician or dentist in the exercise of his/her best judgment may deem advisable. The authorization is given pursuant to the provisions of Sections 25.8 of the Civil Code of California.
This authorization shall remain effective while the child is enrolled in Wayfinder Family Services’ Recreation Programs, unless sooner revoked in writing and delivered. The undersigned further releases Wayfinder Family Services, its officers, agents, and employees from any and all legal responsibility for accidents or sickness occurring during or related to the period of time said person is a participant in programs of Wayfinder Family Services. I (we) further agree and covenant (for valuable consideration, receipt of which is acknowledged) that neither said person or I (we) will institute any suite or action of damage, loss or injury of any kind, whether to person or property, whether to me (us), individually, or as parents/guardians relating to the programs or activities of Wayfinder Family Services (including but not limited to Camp Bloomfield) in which the person participates.
Current Medical Insurance is mandatory in order to participate in any recreation activity or event. Any medical costs incurred while participating in any Wayfinder Family Services’ Recreation Program (including Camp Bloomfield) shall be the responsibility of the participant’s parent or guardian. Medical costs include: physician visit, emergency room visit, prescription medication, and/or emergency transportation. It is also to be understood and agreed that any and all such medical, dental, hospital, or similar expenses incurred in the treatment of the participant will be borne solely by the parent or guardian. If a situation requires medical treatment, the parent or guardian will be contacted by a staff member and informed of the situation. Should a situation arise where the parent or guardian cannot be reached, the participant will be taken to the local emergency facility for treatment.
I have read and agree to the PARTICIPANT//PARENT/GUARDIAN MEDIATION AND ARBITRATION AGREEMENT:
(Required)
PARTICIPANT//PARENT/GUARDIAN MEDIATION AND ARBITRATION AGREEMENT
This is an Agreement to mediate and arbitrate all unresolved disputes arising from the educational, recreational, special education school, and residential services between the undersigned camper and/or their legal guardian and the Wayfinder Family Services.
Media Release
Media Release
(Required)
I have read and agree to the MEDIA RELEASE
Permission is hereby given to WAYFINDER FAMILY SERVICES® to use audio, video recordings, photographic and electronically created images of the camper noted in this application for public view, including publications, websites or social media sites. Usage of any images or audio is without compensation to said person or to the undersigned on his/her behalf, or individuality.
Name/Signature
(Required)
Type your full name to sign
Notes (optional)
Please note any questions or concerns here and we will be in touch. Thank you!
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