Please complete the form below.
Required Fields *
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.
Please complete the fields below. If this is the Camper’s first year at camp, a medical form completed by a doctor may be requested by the Camp Manager.
Asthama Alzheimers Chest Pain Diabetic (med. controlled) Diabetic (insulin dependent) Eczema Hay fever and/or hives Headaches Heart Disease Hypertension GI Concerns (explain below) Severe Osteoporosis Other
Yes No
Yes
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
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
Enter your email address below to subscribe to our newsletter. You can unsubscribe at any time.
Subscribe