Please complete the form below.
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Please note that ALL weeks are now full. You can continue with registration and be placed on a waiting/cancellation list if you choose.
- R&R- Adult I- Adult II- Independent- Youth
If you would like to be placed on the waiting list, please continue with this questionnaire and you will be wait listed in the order received.
We can take more Campers each week if we have more volunteers - spread the word and tell potential volunteers to check out this page.
Please provide 2 emergency contacts for the camper. **Both emergency contacts MUST be available to pick up the camper at any time throughout the week in case of early dismissal for any reason as determined by Directors and/or Manager.
A copy of the camper’s MAR (medication administration record) MUST be provided to camp at time of camper drop off or before. You can request this directly from your pharmacy.
Regarding the registered camper, what level of assistance is required for the following tasks...
Full Physical Assistance Required Minimal Physical Assistance Required Verbal Prompting Required Independent
Full Physical Assistance Required Minimal Physical Assistance Required Verbal Prompting Required Independent N/A
Please note that any communication aids need to be sent with the camper.
Verbal Written Gestures Sign Language Word board/book (PECS) Other
Yes No
Please note that any aids must be sent with the camper.
Walker Wheelchair None Other
Independent Minimal physical assistance Dependent - Full physical assistance Mobility aid used ONLY for greater distances
Requires a life jacket Can utilize the deep end Can utilize the hot tub Can utilize any extra equipment on site (float toys, slides, rafts, etc.) Other
If the camper utilizes incontinence products, please send with the camper.
No concerns (full bladder & bowel control) Partial (occasional accidents) Incontinent (at all times) Incontinent (at night only) Other
Please note that depending on the dietary requirements, the camper may be requested to bring their own food or supplements.
No Soft foods only Blended meals (no solid food) Other
Please note that if a behavioral support plan (a document that describes behavior of concern along with signs of anxiety and how to address the concerning behaviors) is in place for the camper, a copy MUST be provided to camp.
Yes No Unsure
Yes
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