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Camp Lots of Fun Required Registration Information 2023

1. Camper's Name: *This question is required.

2. Emergency Contact (other than parent/guardian) & Daytime Phone Number *This question is required.

3. What is the camper's diagnosis in general terms? (Autism, Down Syndrome, ID, DD, etc. This information will only be used in case of an emergency and a medical response is required. *This question is required.

4. Does the camper have epilepsy or any kind of seizure disorder? *This question is required.

Please list seizure type(s).

Has the camper had a seizure within the last year?

5. Is the camper taking medication of any kind? (This information will only be used in case of an emergency and a medical response is required.) *This question is required.

Please list camper's medications below.

6. Will the camper need to take any medication during camp hours? *This question is required.

List medication and time it needs to be taken while at camp.

7. Please list allergies (food, medications, insect bites/stings, latex, etc.). If none, please answer "NONE." *This question is required.

8. Are there any other special precautions or any life-threatening health concerns we should be aware of? *This question is required.

Please describe any special precautions or life-threatening health concerns. *This question is required.

9. Does the camper sunburn easily? If so, please send spray-on sunscreen daily. *This question is required.

10. Will the camper take and follow basic instructions and/or directions? *This question is required.

11. Camp Lots of Fun can be loud and may be overwhelming to those who are sensitive to noise. If the camper becomes overwhelmed, what suggestions or strategies can you give to help calm them and ensure that they are successful? *This question is required.

12. Does the camper use any special equipment to ambulate (walker, wheelchair, crutches, cane, etc.)? *This question is required.

What equipment does the camper use to ambulate? *This question is required.

13. Camp Lots of Fun will be held in a park that has a pond and is positioned between 2 busy streets, including Meridian Ave. Does the camper have a tendency to wander or run off? *This question is required.

14. Can the camper use the bathroom without assistance. *This question is required.

15. How old will the participant be at camp? *This question is required.