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Waiting List Application Form
Parent's First and Last Name *
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Phone Number *
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Today's Date *
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DD
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Email *
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Mailing Address *
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Child's First and Last Name *
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Gender
Does a sibling already attend camp? *
Current School Attending *
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Current Grade Level *
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Age *
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Areas of Disability
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Please check all that apply: (To qualify for camp, individual must have at least one) *
Required
Primary Goal *
In 250 words of less, please provide a brief description of your child's strengths and needs (i.e. verbal/nonverbal, toilet trained, socially motivated, eats with assistance). Include any specific concerns you may have (communication, behavior, or other).
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