Programs
About Us
Register
Forms
Jobs
Ways to Help
Locations
Rent Camp
Resources
Calendar

Select a Site to Jump to...

Easter Seals Wisconsin
Respite & Recreation Programs
FARM Program
Self-Employment Services Program
Donation Center (schedule a donation)
Education & Community Services

Make a Difference through a Gift

$

Request More Sessions

Please complete the following for to register for additional sessions. All required fields have an asterisk (*).

Camper Name: *

Mailing Address: *

City, State, Zip: *

Home Phone: *

Other Phone:

E-mail: *

Program: *

Wawbeek Program

Trailblazers Program

Elks Respite Program

Asperger Syndrome and High-Functioning Autism Program

Fox Valley Day Camp Program

Bring-a-Buddy Program

Sessions you want added:: *

Funding Source: *

Please use the funding source I listed on my application already

I will pay for the camp fee

A County Program or Organization will pay

Please list who will be paying for your session.

Name of Funding Source:

Contact Name:

Funding Source Address:

Funding Source City, State, Zip:

Funding Source Phone:

Total amount to be billed for this funding source is: $

Printer-friendly version
Send to friend
PDF version

Easter Seals Wisconsin • 101 Nob Hill Road, Suite 301 • Madison, WI 53713
608-277-8288 (voice)
608-277-8333 (fax)
800-422-2324 (toll-free)

Easter Seals Wisconsin does not discriminate on the basis of race, color, national origin, age, religion, disability, sex,
sexual orientation, political affiliation, military service or marital or parental status.