Register for Corvallis Summer Club 2026

For questions, email Abby Guzman at aguzman@arcbenton.org.

Payment is not due at this moment. Please note payment will be due upon enrollment confirmation.

Note: The Arc of Benton County Summer Club is a community event and not a Medicaid Funded Day Support Activity Program and does not provide direct support. PSWs, DSPs, and other support staff are welcome to attend along with club member if that level of support is wanted/needed. Registration does not automatically guarantee a spot in the summer club.

Club Member's Information

The following sections are for the Club Member's information only.
Full Name
Name Club Member goes by
Pronouns
Primary Address
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
If club member does not have an email, please use a parent/guardians email.
Do you need a scholarship to attend the Summer Club?
Scholarship funds are limited and those demonstrating both need and a commitment to attend and engage will be prioritized.

Club Member's Emergency Contact Info

In case of an emergency, who do we contact?
Emergency Contact 1
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
Relationship to Club Member
Emergency Contact 2
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
Relationship to Club Member

Please use the following chart to calculate how much a Summer Club Membership will cost.

Attend 1 time a week for 6 weeks Attend 2 times a week for 6 weeks Attend 3 times a week for 6 weeks
Total Cost of Attending $180 $360 $540

Summer Club Day Preferences

Please indicate the day(s) you want to attend the Corvallis Summer Club. Remember: If you select Tuesdays, you are signing up for all 6 Tuesdays. If you sign up for Tuesdays, you are signing up for all 6 Tuesdays. If you sign up for Wednesdays, you are signing up for all 6 Wednesdays. If you sign up for Thursdays, you are signing up for all 6 Thursdays.
Do you want to attend on Tuesdays - Arts & Crafts?
Do you want to attend on Wednesdays - Fun & Games?
Do you want to attend on Thursdays - Movement & Mindfulness?
If you picked more than one day, what is your FIRST choice day to attend?
If you picked more than one day, what is your SECOND choice day to attend?

Additional Club Member Information

Do you, the club member, require direct support or supervision during summer club hours?
If you indicated "Yes" in the above question, who will support you, the Club Member, during Summer Club hours?
Can you, the Club Member, use the restroom independently?
Can you, the Club Member, move around the community independently?

Final Questions

The following questions are to be completed by both the summer club member and their parent/guardian or support staff.