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Camp Sensory House 2026 Registration Form
Please fill out each question completely. 
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Email Address *
Please Check the week(s) your camper will attend *
Required
Camper's first and last name *
Does your child have a preferred name or nickname? *
Birthdate/Current age *
MM
/
DD
/
YYYY
Gender *
Diagnosis (optional)
Parent/ Guardian Information
Name(s)
 *
Relationship to Child *
Phone number(s) *
Home address *
Emergency Contact (other than parent/guardian)
Name
 *
Relationship to Child *
Phone Number(s) *
Medical and Allergy Information
Does your child have any allergies? If yes, please explain.
 *
Does your child have any medical conditions that we need to be aware of? If yes, please explain. *
Medications taken regularly (if any) *
Sensory & Communication Support
Sensory sensitivities (Yes/No). If yes, please explain.
 *
Preferred communication style (verbal, gestures, AAC, etc.) *
What are some strategies that help with transitions or regulation. *
Pick-up authorization
Please list person 1 name/phone/relationship to child
Person 2 Name/ Phone/ relationship to child
 *
Photo & Video Release Waiver
Used for social media and webpage
 *
Payment: Click the link to submit payment.  *
Agreement & Signature *
Required
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