2022 Conference Camp Wonder Registration 2022 Camp Wonder at PeDRA Annual Conference Registration Registration must be completed by a parent or adult caregiver of the camp participant no later than Wednesday, October 26, 2022. Permission to participate By checking the box, I hereby grant permission for my child to participate in Camp Wonder at PeDRA. Acknowledgement of age By checking the box, I hereby acknowledge that the Camp Wonder at PeDRA registered participant is over the age of 6 and under the age of 18. Children that will be 5 years old on November 3, 2022, may still be eligible to participate if they are potty-trained. Camper's First Name Camper's Last Name Only last initials will be used on the badges. Camper's age on November 3, 2022Please select... 5 6 7 8 9 10 11 12 13 14 15 16 17 If they have one, please provide the camper's nickname: Please indicate below the camper's desired pronouns to be listed on their name badge.Please select... He, him, his She, her, hers They, them, theirs Other Camper prefers not to have pronouns listed on the conference badge. Please provide the camper's parent or guardian's name and email address. First Name Last Name Parent or Guardian's Email If applicable, please provide the name of the organization or patient community with which you are involved: Will the parent or guardian also be joining us in person for the 2022 PeDRA Annual Conference? YesNoIf yes, please register for the 2022 PeDRA Annual Conference here. Current Street Address City CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau State/Province ProvincePlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Postal Code What type of address is this?PersonalBusinessOther Photography and Videography PeDRA may capture photographs and video during the 2022 Mini Camp Wonder at the PeDRA Annual Conference. Click here to view PeDRA's Photography and Videography Release. By checking this box I certify that I agree to the terms of PeDRA Photography and Videography Release on behalf of the camper. PeDRA is committed to supporting equity, diversity, and inclusion across all facets of its organization, programs, committees, leadership, and research studies. We ask for demographic information from PeDRA Annual Conference attendees to ensure we have accurate and complete data to help achieve this goal. All data collected is kept safely and only de-identified aggregate data will be shared strategically. Please specify the camp participant's gender:FemaleMaleNon-binaryI do not wish to provide this information. With what race(s) does the camp participant self-identify? Please select all that apply. Please select... American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Middle Eastern or Northern African Native Hawaiian or other Pacific Islander White Other - write in I do not wish to provide this information. Other - write in race: Accessibility and Special NeedsPursuant to the Americans with Disability Act (ADA), do you have any special needs or requirements? Please indicate any special dietary needs: Please select... None Vegetarian Other Other special dietary needs: Commitment to Safety and HealthPeDRA is committed to providing a safe and healthy environment for all conference attendees, exhibitors, partners, campers, and the administrative team. Available data suggest that patients with mild-to-moderate COVID-19 remain infectious no longer than 10 days after symptom onset. Therefore, PeDRA asks that if the camper is diagnosed with COVID-19 within 10 days of symptom onset and within 10 days of the start of the Annual Conference, you notify PeDRA to cancel your child's registration. PeDRA will continue to monitor the status of COVID-19 infections in the U.S., and the Bethesda, MD area and make appropriate modifications as needed. PeDRA asks parents and guardians of the camper to pay attention to the conference website and communication from PeDRA that may reflect updated guidelines for participationPeDRA asks that all attendees respect each other's preferences for masking and social distancing and allow individuals to move at their own pace. Acknowledgment of Personal Responsibility for 2022 Mini Camp Wonder at PeDRA Annual Conference campers:I acknowledge that PeDRA cannot guarantee that my child and/or I will not be exposed to or in contact with a Communicable Disease (e.g. COVID-19) at the 2022 Mini Camp Wonder at PeDRA Annual Conference and I understand the risk that myself and my child may be exposed to or infected by a Communicable Disease by attending. I knowingly and freely assume all such risks, both known and unknown, and take full personal responsibility for my child's and my participation in the conference.I agree to abide by all applicable COVID-19-related requirements, advisories, policies, procedures, and protocols of the event hosts (PeDRA), the Bethesda North Marriott Hotel and Conference Center, as well as respective PeDRA partners, and any other governmental authority for the duration of the event.With my response below, I release PeDRA, and its Meetings Committee, the Board of Directors, staff, and contractors from liability should my child or I become ill, directly or indirectly, as a result of my participation in this event.I acknowledge personal responsibility for myself and my child. In addition to conference updates, do you wish to receive regular updates from PeDRA via email? Yes No Contact Information Return to conference home page
