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We Care AACamp! (3-8 years of age)
Parent/Caregiver Form for Child Admission to Camp
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Peer Mentor or AAC User?  *
Child's Name *
Date of Birth (3-8 years of age) *
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DD
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Gender *
What weeks of camps are you available for? (2 week minimum) *
Child Shirt Size
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Name of Parent(s)/Caregiver(s) *
Sibling Name(s) and Age(s) *
Home Address *
Parent/Caregiver Cell Phone *
Parent/Caregiver Email Address
Race *
What languages are spoken in your home?  *
Diagnostic Information: Any Diagnoses?  *
Diagnostic Information: Age of Diagnosis
 *
Diagnostic Information: Diagnosing Physician? 
 *
Does your child now, or has your child ever, attended school? If yes, please describe the educational setting and days/duration.  *
Does your child receive any of the following therapies?  *
Required
Allergies?  *
Please list any medications that must be administered during session times.  *
Any physical limitations? If yes, please explain.  *
Emergency Medical Information: Name of Physician & Hospital of Choice & Phone Number  *
Emergency Contact Information  *
Please describe your child socially. Include age of peers he/she enjoys. Include age of peers he/she enjoys; interests; games enjoyed; activities enjoyed; etc.  *
Please describe your child's communication, including any strategies that are helpful to assist your child.  *
Please add any comments you feel we should know and areas of concern related to your child.  *
Highly Preferred Items/Activities  *
Extremely Disliked Items *
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